December 3, 2008

LSMS Asked to Present at LA Health First Legislative Briefing

The LSMS appeared before the full House of Representative on Monday, December 1^st to provide its assessment of the Concept Paper describing Governor Jindal's proposed Medicaid reform program called Louisiana Health First (LHF). In the morning members of the House heard a presentation on the program by Secretary Alan Levine followed by extensive questions and responses. Following lunch the House heard presentations by LSU Health Sciences Center, the Louisiana Hospital Association (LHA), the LSMS and the Louisiana Association of Health Plans (LaHP). Making the presentation on behalf or the LSMS were Dr. Roger Smith, LSMS President; Dr. Floyd Buras, LSMS Past President; and Dr. Bart Farris, Speaker of the LSMS House of Delegates.

On November 6, 2008, the LSMS released a position statement opposing the plan design for Louisiana Health First because physicians had not been adequately informed on the design and had not been provided access to the waiver which embodies the intended plan to be implemented. This lack of transparency was an obstacle to evaluating the feasibility of the proposed plan on which the waiver request is predicated. Under the time schedule DHH had established, the waiver was to be presented for federal review in late November. No one really knew what was in the waiver, prompting the LSMS Board of Governors to take action. Read the LSMS statement released in November regarding the Louisiana Health First project.

On Friday, November 14, 2008, Governor Jindal and DHH Secretary Alan Levine held a press conference at the Governor's Mansion to release the Concept Paper and the White Paper "Louisiana Health First Health Care Transformation Concept." Following the release of the Concept Paper, Speaker of the House of Representatives Jim Tucker scheduled a special briefing for members of the House on December 1, 2008. DHH Secretary Alan Levine made a presentation on Louisiana Health First in the morning. After lunch the invited groups made presentations and answered questions from members of the House. The LSMS addressed several concerns about the current plan design and presented recommendations based on LSMS reform proposals contained in Health Access Louisiana and the Access to Better Care.

News & Views: LA Health First

Health-care plan called misdiagnosis, The Advocate http://www.2theadvocate.com/news/35450584.html

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Levine, House discuss revamp, The Advocate http://www.2theadvocate.com/news/35355924.html?showAll=y&c=y

Letter: Plan ignores best alternative, Times Picayune http://www.nola.com/timespic/stories/index.ssf?/base/news-12/1228112498291090.xml&coll=1

Hurricane Ike Disaster Relief

On November 5, 2008, the LSMS Board of Governors passed a motion to donate $15,000 to the Texas Medical Association Hurricane Ike Disaster Relief Fund.

The LSMS is making this donation in part to express its deep appreciation to the Texas Medical Association (TMA) for their generous donation to the LSMS Hurricane Relief Fund in 2005. The LSMS Board of Governors urges Louisiana physicians to consider making a personal donation to the TMA Hurricane Ike Disaster Relief Fund and to help our neighbors in southeast Texas rebuild their practices and begin to restore health care services to their communities.

"We now have the opportunity to help our fellow physicians in Texas whose lives have been impacted by Hurricane Ike and to return the kindness shown to us by the TMA in our time of need," said Roger Smith, MD, LSMS President. There are approximately 1,000 Texas physicians and medical students, mostly in the Galveston area, who need help to cover devastating losses caused by Ike. The main purpose of the TMA Relief Fund is to help reestablish the delivery of medical care to the hardest hit areas of the Texas Gulf Coast. For more information, please visit the LSMS web site at http://www.lsms.org/cms/about-us/34/290.

2009 Medicare Physician Payment Rule Published

On November 19, the Centers for Medicare and Medicaid Services (CMS) published a final regulation in the Federal Register on the 2009 Medicare physician payment schedule. The rule describes numerous changes that take effect in 2009, including: an across-the-board payment update of 1.1% as required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA); a 2% incentive payment for reporting on Physician Quality Reporting Initiative (PQRI) measures; and an additional 2% incentive payment for electronic prescribing. In addition, the rule reflects the final phase-in of the most recent update to the geographic practice cost indices (GPCIs); the third year of the transition to revised practice expense relative values; changes in certain relative values due to adoption of RUC recommendations; and a shift of the budget neutrality adjustment from the work relative values to the conversion factor. When the various changes in payment rates for services are combined, those specialties estimated to benefit most, with an average 4% increase, include infectious disease specialists, psychiatrists and emergency physicians, followed by 2-3% increases for anesthesiologists, cardiac surgeons, colorectal surgeons, intensivists, family physicians, gastroenterologists, general surgeons, geriatricians, internists and several others. Specialties experiencing average decreases of 1%-2% include allergists, cardiologists, oncologists, and nuclear physicians. No net payment changes are estimated for radiologists, urologists, ophthalmologists and orthopedic surgeons.

A 60-day public comment period on certain elements of the final rule will close on December 29. Please note, however, that comments will not affect 2009 payment rates and policies but may influence policy for future years. The final rule is available at: http://www.access.gpo.gov/su_docs/fedreg/a081119c.html

Participate in Your State Medical Society

The LSMS requests your participation in making our organization more efficient and effective each year. It's time to volunteer to serve on the following councils: Council on Member Services, Council on Socioeconomics and the Council on Public Health. The following standing committees are also in need of volunteers: Committee on Charter and Bylaws, the Medical Legal Interprofessional Committee and the CME Accreditation Committee. Volunteer by contacting the Administration & Member Services Department at 6767 Perkins Road, Suite 100, Baton Rouge, Louisiana 70808; fax 225.763.2333 or send an e-mail to administration@lsms.org.

November 6, 2008

LA Medicaid Cuts Halted, State Now Projects Budget Surplus by Jim Harris , Harris, DeVille & Associates, Inc.

Louisiana Department of Health and Hospitals this week said that there will now be a $100 million surplus in the state's Medicaid program. The announcement was a turnaround from the projected $81 million deficit that department officials had earlier contended would occur in the program. DHH officials spent weeks attempting to garner support for cuts from the Joint Legislative Budget Committee based on their earlier projections. Louisiana Hospital Association and others contended that it was too early to project deficits in the program. In reversing its position, DHH now says that hurricanes Gustav and Ike prompted many hospitals to cancel or postpone many elected procedures and also forced the department to postpone advancement of the program that provides home-care to people with disabilities.

News and Views: LA Health First

Reversal on DHH cuts irks lawmakers, http://www.2theadvocate.com/news/33677404.html (Saturday, November 1^st, by Marsha Shuler)

Jindal: Health care should be left to patients, doctors- NOLA.com (Thursday, Oct 23, 2008, by Jan Moeller)

BCBSLA Announces Change in Extended Inpatient Hospital Stays Policy

Effective for admissions beginning February 1, 2009, Blue Cross will no longer pay admitting physician charges for days a patient spends in the hospital beyond the approved number of days determined to be medically necessary. This applies to extended stays denied due to insufficient medical, investigational and medical necessity reasons. This policy will apply to both partial and full inpatient denials. All admitting physicians and facilities will be notified of the member's approved number of inpatient days and will be made aware that no payment will be made to the admitting physician for any days beyond the approved number. This change affects all Blue Cross and Blue Shield of Louisiana, HMO Louisiana and Federal Employee Program (FEP) members. If you have any questions regarding this change, please call Provider Services at (800) 922-8866.

CMS Issues Final Rule on Physician Payments for 2009

On October 30, 2008, the Centers for Medicare and Medicaid Services (CMS) issued a final 2009 Medicare physician payment rule that replaces a scheduled 15.1% cut with a 1.1% increase as required under the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). In addition to the physician payment rule, CMS also put its final rule for payments to hospital outpatient department (HOPD) and ambulatory surgical centers (ASC) on display today.

The physician payment rule, which will be published in the Federal Register on November 19, is on display at http://federalregister.gov/OFRUpload/OFRData/2008-26213_PI.pdf

The HOPD/ASC rule will be published on November 18 and can be viewed at http://federalregister.gov/OFRUpload/OFRData/2008-26212_PI.pdf

Participate in Your State Medical Society

Two LSMS Members Appointed to LAMMICO Board of Directors

Physician-members John G. Burvant, MD, of Metairie and N. Joseph Deumite, MD, of Baton Rouge were recently appointed to the LAMMICO Board of Directors. Dr. Burvant, a graduate of the Louisiana State University (LSU) School of Medicine - New Orleans, is a practicing orthopedic surgeon with the Pontchartrain Bone and Joint Clinic in Metairie. He will also continue to serve LAMMICO's Underwriting Committee. Dr. Deumite of Louisiana Cardiology Associates in Baton Rouge will continue to serve LAMMICO as a member of the Claims Committee. Also a graduate of the LSU Medical School in New Orleans, Dr. Deumite has been in private practice at Louisiana Cardiology Associates in Baton Rouge for over 20 years. Dr. Deumite is also a clinical instructor at the Earl K. Long Hospital and serves as an associate professor at the same facility for LSU Medical School in Baton Rouge.

EHR Grants for LA Primary Care Physicians, DEADLINE: NOV 26, 2008

CMS and the Louisiana Health Care Quality Forum (LHCQF) are partnering in the Electronic Health Records Demonstration project, a five-year demonstration project that will encourage small to medium-sized primary care physician practices to use electronic health records to improve the quality of patient care. The demonstration is designed to show that widespread adoption and use of EHRs will reduce medical errors and improve the quality of care. For more information, please contact Will Jackson by e-mail at wjackson@lhcqf.org or visit www.lhcqf.org.

Flu Shot Reminder

Flu Season Is Upon Us! Begin now to take advantage of each office visit as an opportunity to encourage your patients to get a flu shot. It's still their best defense against combating the flu this season. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don't forget, health care personnel can spread the highly contagious flu virus to patients.

Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare's coverage of the influenza virus vaccine and its administration as well as related educational resources for health care professionals, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website.

October 8, 2008

2008 Annual Meeting

LSMS' Annual Meeting of the House of Delegates wrapped up its official business on Friday, October 3^rd with the inauguration of the 129^th president, Dr. Roger D. Smith, a board-certified neurosurgeon at Ochsner Health System in New Orleans. Visit www.lsms.org for additional highlights of LSMS' Annual Meeting. Complete coverage of actions taken by the House of Delegates will be in the November issue of Capsules.

DHH Projects Budget Deficit, Urges Quick Decision on Cuts

On October 3, 2008, DHH Secretary Alan Levine reported to the Joint Legislative Committee on the Budget on his proposal to address an $81 million deficit in the Medicaid Program. Secretary Levine submitted a plan that would cut health care providers' reimbursements, including a $21 million reduction in physician payments. His plan also calls for changes in hospital financing and updating the system through which doctors and hospitals get Medicaid reimbursements to avoid duplicate payments and overpayments. The Joint Legislative Committee delayed any action, citing that the committee members needed more time to research and understand the numbers the agency had provided. Ten to twelve physicians attending the LSMS Annual Meeting went to the committee meeting to voice their concerns.

Read the latest:

La. health secretary warns of deeper budget cuts (Associated Press story, New Orleans Times-Picayune) http://www.nola.com/ap/stories/index.ssf?/base/news-42/122340595166960.xml&storylist=topstories

DHH chief says budget delays mean cuts (The Advocate) http://www.2theadvocate.com/news/30608174.html?showAll=y&c=y

Committee delays action on cuts in DHH spending (The Advocate) http://www.2theadvocate.com/news/30457149.html

Medicaid Overhaul Moving Too Quickly

Despite delays from Hurricanes Gustav and Ike, Governor Bobby Jindal's administration is still pushing to get federal approval of the state's Medicaid overhaul plan, Louisiana Health First. Objections from some members of the advisory panel are growing louder as questions regarding the plan's details have yet to be answered.

Read the latest:

Medicaid overhaul races clock (The Times-Picayune) http://www.nola.com/timespic/stories/index.ssf?/base/news-6/1223011465131460.xml&coll=1

UPDATE: EHR Demonstration Project Audio-Conference

The Centers for Medicare & Medicaid Services in collaboration with the Louisiana Health Care Quality Forum are working to implement a five-year demonstration project in the State of Louisiana focusing on electronic health records in small-to-medium-sized primary care physician practices. A conference call will be held on Thursday, October 9 from 7:30-9:00 AM CDT to provide information about this demonstration and to answer questions from physicians who may be interested in participating.

Applications to participate in the demonstration must be received by November 26^th. There is no pre-registration. For more information, please contact Will Jackson by e-mail at wjackson@lhcqf.org or visit www.lhcqf.org.

Tamper Resistant Rx Pads

On October 1, 2008, any Rx written for a Medicaid patient must be on a tamper resistant prescription pad and that pad must contain all three of the characteristics listed below:

One or more industry-recognized features designed to prevent unauthorized copying of completed or blank prescription forms.
One or more industry-recognized features designed to prevent the erasure or medication of information written on the prescription by the prescriber.

One or more industry-recognized features designed to prevent the use of counterfeit prescription forms.

This rule applies to all written (non-electronic) prescriptions for outpatient drugs reimbursed by the Medicaid Pharmacy Program. This rule was the result of federal legislation. All Medicaid Providers in the State where notified of the deadline for compliance via letter dated August 29, 2008. To read this letter go to: http://www.lamedicaid.com/provweb1/Pharmacy/Tamper_Provider_Letter.pdf. The Louisiana Medicaid Office also has a webpage that contains other sources of information about the rule and how to obtain compliant Rx forms at this link: http://www.lamedicaid.com/provweb1/Pharmacy/TamperResistant.htm.

Revision of Rules Regarding Dispensation of Medications in Physician's Offices

Under new rules promulgated by the Louisiana State Board of Medical Examiners (LSBME), only physicians who are registered as dispensing physicians with the LSBME can dispense or provide samples of any controlled substance or other "drugs of concern." On September 20, 2008, a new rule became effective which mandates that registered dispensing physicians can no longer dispense more than a single 48 hour supply of any controlled substance or a "drug of concern" to a patient. "Drugs of concern" are defined as carisoprodol, dezocine, nalbuphine, tramodol and such other non-controlled substances, which demonstrate a potential for abuse. There are certain exceptions to this rule contained in Section 6506. Questions regarding the new rule should be directed to the LSBME at 504.568.6820. Click here to review the new rule in its entirety.

Medicine & Religion Week 2008

The LSMS has designated October 13-17, 2008, as Medicine and Religion Week, an annual observance recognizing the role of an individual's spiritual beliefs in the healing process, as well as an individual's choice to seek divine wisdom and guidance. As part of the observance, the LSMS invites all clergy, hospitals, civic organizations, and groups statewide to participate by including the Medicine and Religion Week information in scheduled meetings and activities. Spiritual essays written by LSMS physicians are available for reprint in printed publications as well. A planning guide is available for groups or organizations interested in coordinating Medicine and Religion Week events locally. Some examples include hosting a special event, inviting local religious leaders as guest speakers, and holding panel discussions to observe Medicine and Religion Week. Activity coordinators are encouraged to notify the LSMS of any Medicine and Religion Week events planned by contacting Sadie D. Wilks at sadie@lsms.org or by phone at (225) 763-8500.

September 11, 2008

LSMS Initiates Electronic Newsletter

At its meeting on August 13, 2008, the Board of Governors voted to begin sending a new electronic newsletter to the LSMS membership monthly. This new format will be approximately one to two pages with summary paragraphs covering important LSMS activities, breaking medical news and announcements. The Update is intended to provide a quick summary of information that will be a useful resource to physician leaders and component societies, as well as individual members. This new communications piece will keep you posted on important events between issues of the printed newsletter, Capsules, and The Journal of the LSMS. Each issue of the President’s Update will be available on the LSMS Web site at www.LSMS.org.

2008 House of Delegates

The 128th Annual Meeting of the LSMS House of Delegates (HOD) is STILL scheduled for October 2-4 at the Hilton Capitol Center in Baton Rouge. Each year, the HOD actions frame the LSMS agenda for the coming year. Other activities include a reception honoring physicians who have been practicing for 50 years, an Awards Luncheon, and the President’s Inaugural Dinner. The opportunity to participate in the HOD is a great way to learn more about what the Society does on behalf of all physicians and the great potential we have as physicians help shape public policy on the delivery of health care. Contact your component society about becoming a delegate to the meeting. Join your colleagues across the state to protect and strengthen our freedom to practice our profession and serve the needs of our patients. Register Today!

Medicaid Reforms Moving Fast by Dr. Steven B. Spedale

The Health Care Reform Act of 2007 by the Louisiana legislature instructed the Louisiana Department of Health and Hospitals (DHH) to implement a medical home system of care that will incorporate the use of health information technology and quality measures to create a safe, patient centered, quality driven, sustainable health care system for Medicaid recipients and low-income uninsured citizens. The major project in this regard will be the implementation of Provider Service Networks (PSN) called Louisiana Health First in the Baton Rouge, Lake Charles, New Orleans and Shreveport regions. Secretary Alan Levine appointed a Technical Advisory Group for Louisiana Health First which held its first meeting August 12th. Presentations regarding PSN definition, implementation, and roles as elements of reform were given by DHH staff. These presentations can be found at http://www.dhh.louisiana.gov/offices/?ID=349.

The future for our Medicaid patients as well as our colleagues that treat these patients is unclear at this time. It is up to each of us to be fully informed of the potential implications of the PSN model in Louisiana as it will affect the lives of all Medicaid recipients in each of the rollout regions, require provider ownership in a PSN, and possibly capitation as a means of reimbursement. Read the entire article in the September 2008 issues of Capsules.

EHR Grants for LA Primary Care Physicians

LSMS Volunteers Needed to Fill Vacancies on State Boards, Commissions

Each year, the LSMS is asked to nominate individual physicians to serve on more than 50 boards and commissions across the state. If you have a special interest in volunteering, there are many specialties and issue-specific groups providing you an opportunity to choose one that suits your interests. Find out more information by contacting Geraldine Leche at 225.763.8500. Assistance is available in determining if the new disclosure laws will affect you.

Nominations Sought for $100,000 Award

The Kanter Prize, the Joseph H. Kanter medal, diploma and $100,000, will be awarded yearly to a community physician practicing in the United States. The LSMS has been asked to submit one nominee to be selected by the Board of Governors. Sponsored by The Health Legacy Partnership, a public-private partnership between the Agency for Healthcare Research & Quality (AHRQ), and the Joseph H. Kanter Family Foundation, the award was established to recognize and to celebrate the talent, dedication and creativity of a practicing physician. Nominee applications will be reviewed and finalists will be notified of his or her status by the Kanter Prize Selection Committee. If you would like to interview or submit the name of a physician to be considered by the BOG, please contact Geraldine Leche at 225.763.8500. All names must be received by the LSMS by October 20, 2008.

Eligibility

Qualifications to become a recipient of the Kanter Prize include:

The candidate must be a licensed practitioner of medicine in the United States, currently practicing medicine in the United States, currently in good standing with his/her state of licensure and exhibit excellence in his/her chosen medical field.
The candidate must be a United States citizen licensed as a Doctor of Osteopathic Medicine (DO) or a Doctor of Allopathic Medicine (MD).
The candidate’s efforts must have contributed to diminishing healthcare disparities in the United States and be such that they can serve as a remedy for an existing healthcare disparity by having put into effect or having an effective operational plan that will diminish healthcare disparities.
The candidate must not have a current or past affiliation with the Joseph H. Kanter Family Foundation and/or the Kanter Prize committee.
Nominees must agree to the nomination, sign a letter of consent, and attest to the accuracy of the nominating information, and/or independent verification of professional accomplishments.

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