President's Update

March 3, 2010

The Latest on Medicare Cuts

The Senate voted 78-19 to pass H.R. 4691, the "Temporary Extension Act of 2010," which included provisions to extend 2009 Medicare physician payment rates through the end of the month. As a result, the 21% payment cut that took effect on March 1 has been postponed until April 1. Discussions are still underway in the House and Senate on the next steps that will be taken to address the Medicare payment crisis. Proposals are being circulated that would implement still another short-term patch to the sustainable growth rate (SGR) formula, including proposals that would postpone cuts for 90 days, 7 months, or through the end of 2010.

On March 3, 2010, the Centers for Medicare and Medicaid Services (CMS) announced its intention to stop the 10-day hold on physicians' Medicare claims in light of recent legislative action to extend current Medicare payment rates through March 31, 2010. President Obama signed into law the Temporary Extension Act of 2010 on March 2, 2010, which extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010. Consequently, effective immediately, claims with dates of service March 1 and later which were being held by Medicarecontractors will be released for processing and payment. Statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).

Looming Cuts Create Perfect Health Care Storm

With the revelation last month that Governor Jindal's proposed state budget for 2010-2011 will have $355 million less in funding for the Medicaid program than last year's budget, a health care crisis is gathering for a third of Louisiana's population. According to DHH, the 2010-2011 budget shortfall could result in a 3.1 percent cut in provider reimbursement. Over a two year period (2009-2011) combined potential cuts of 18 percent in the Medicaid budget to individual health care providers in combination with an impending 21.5 percent cut to Medicare physician reimbursement now effective April 1, 2010, will force Louisiana physicians to make tough choices.

With nearly 30 percent of Louisiana's population dependent on state programs for health care, many physicians depend on these program reimbursements to keep their doors open. "Access to care continues to be a growing issue in Louisiana," explained Dr. Patrick C. Breaux, LSMS President. "A combination of impending state and federal cuts will surely exacerbate this long-standing problem. Medicaid patients will have increased difficulty in finding or keeping a physician, and they will become even more dependent on the already overburdened safety net system. More patients will begin to seek care in hospital emergency rooms, driving up costs while hospitals are receiving less Medicaid reimbursement due to continuing budget cuts."

In a February 2009 LSMS survey, 87 percent of respondents found it "difficult" or "almost impossible" to refer patients to physicians for certain specialty care services; and over 64 percent of survey respondents indicated it is difficult to recruit new physicians. The primary reason noted was low reimbursement rates in Louisiana, even before the FY 2009-10 Medicaid cuts dropped reimbursement from the 90th percentile to the 80th of Medicare allowable for Region 99 and the announcement of the midyear revenue short fall for this fiscal year which resulted in additional cuts dropping reimbursement to an even lower 75th percentile. Dr. Breaux pointed out the state's ratio of physicians per 1,000 of population is below the national average, and with Louisiana's Medicaid enrollment near 30 percent of the population, more payment cuts will discourage physicians from relocating to Louisiana. Moreover, 42 percent of Louisiana's practicing physicians are more than 50 years old, an age at which studies and surveys have shown many physicians are now considering reducing their patient care activities.

"Physicians and patients need to contact our legislatorsand congressmen today,"said Dr. Breaux. "The only way to stave off this devastating blow to health care in our state is for legislative action at both the state and federal level. We cannot continue to reduce reimbursement to providers and hospitals, while expecting them to care for more and more patients. From a fiscal standpoint it simply can not be done."

LSMS 2010 Leadership Conference - CANCELLED!

Please note that the 2010 LSMS Leadership Conference, originally set for Saturday, March 27th at the Hilton Capitol Center in Baton Rouge, has been cancelled.

Central LA medical-access initiative now covers entire state

The Cenla Medication Access Program (CMAP), a Rapides Foundation initiative, provides chronic care prescription medications for people who cannot afford them, as well as promotes preventive health measures. Medications are donated by nine pharmaceutical companies that partner withthe CMAP. Starting with covering the nine Central Louisiana parishes served by the Rapides Foundation, the program expanded by 30 parishes in 2008 after forming a partnership with the Louisiana Bureau of Primary Care and Rural Health. In November, CMAP started covering the entire state. More than 22,000 people have been helped through the CMAP since it was established in 2001.To qualify, you must be a Louisiana resident 18 years or older, with an income at or below 200 percent of the federal poverty level, and without prescription coverage through insurance, Medicaid or Medicare. More information, including eligibility screenings, is available by calling 1-888-443-7494 or visiting www.cmaprx.org.

Call for Comment: Continuing Medical Education

The Accreditation Council for Continuing Medical Education (ACCME) has received feedback from some providers and other stakeholders that pure knowledge-based CME activities are vital to physicians' continuing education and professional development, and that the ACCME should revisit this issue and consider rewording the Criteria. The ACCME is asking the CME community: Should the word knowledge be added into Criteria 1, 3, and 11? The ACCME posted a Call for Comment on its website regarding a possible change in the wording of its Updated Criteria for CME. Please visit their website to post your comment by March 8, 2010.

February 4, 2010

Breaux Assumes LSMS Presidency

The Louisiana State Medical Society (LSMS) installed its 130th president, Dr. Patrick C. Breaux of New Orleans, Louisiana, at the 2010 Annual Meeting of the House of Delegates. The meeting was held January 29-30 at the L’Auberge du Lac Casino Resort in Lake Charles.

First of all, I would like to thank the membership of the LSMS in bestowing on me the honor of serving as President in 2010. Having been given the privilege of the practice of medicine, I feel the need, as most of you, to give back. Katrina opened my eyes to the deeply flawed health care system we had in New Orleans. Charity Hospital, while providing care for millions and training for most doctors and many of the nurses in the state, also was the embodiment of a two tiered health care system and its many disparities. While my intention was to be just a helper in health care reform process, I now find myself as your President.

As a medical society we will need to anticipate and respond better to the changes in practice patterns and physician demographics by offering value to the professional lives of all physicians. As President, I want to focus on expanding membership; defending Act 817 and the medical malpractice cap; opposing any cuts in Medicaid and Medicare; and training our next generation of physicians to be effective leaders.

While health care reform has been temporarily derailed by the Massachusetts Senatorial election, LSMS remains opposed to increased government control and incremental steps toward a single payer system. We support a market based approach to provide health care services and the ability to privately contract. Health care is at its best when it is patient centered and physician guided.

Our next generation of physicians should be active in the reform process. They have the most to gain or lose. In a time of challenge and change there are also opportunities. Let’s rise with a renewed purpose to lead the fight for health care that benefits our patients and provides hope for a promising and rewarding career for future generations of physicians.

Patrick C. Breaux, M.D.

New Orleans, LA

DHH Cuts Physician Reimbursement

On January 20, 2010, new emergency rules were published in the Louisiana Register outlining cuts to physician services, specifically reimbursement rate reductions. Some physicians may see their rates go down to 80% of Medicare rates. Click here to read the emergency rule. Additional changes and revisions to existing emergency rules are forthcoming, and the LSMS continues to work on your behalf to stop or limit these cuts before their implementation. Louisiana Department of Health and Hospitals Secretary Alan Levine announced mid-year reductions in department spending of state general funds, and proposed utilization of other means of financing, in order to offset a $108 million deficit in available funding. DHH's reductions are part of an overall across the board mid-year reduction plan for each agency to help address the state's mid-year budget deficit.

Louisiana Medicaid Announces Radiology Utilization Management (RUM) Program

Louisiana Medicaid will implement Radiology Utilization Management (RUM) to promote the health of Medicaid recipients by ensuring appropriate utilization of Department-defined high-tech imaging studies by Medicaid providers and recipients. Medicaid will partner with MedSolutions Inc. (MSI), to provide prior authorization, monitoring and management of medical imaging services. Beginning with date of service February 1, 2010, primary care and specialty care providers will be required to request prior authorization for non-emergency outpatient Magnetic Resonance (MR), Computed Tomography (CT), and Nuclear Cardiac imaging. Reimbursement to the rendering provider will be contingent on prior authorization. Providers will be receiving information from MedSolutions, Inc. detailing the prior authorization procedures along with invitations to attend webinars to learn more about the program. Information will also be available for providers via a link on the Louisiana Medicaid website, www.lamedicaid.com, remittance advice messages, and other forms of communication. Providers should continue to monitor the Medicaid website for the most up to date information regarding this program.

AMA, Others Petition FTC for Relief from Red Flags Rule

Following a recent federal court decision, four national organizations including the AMA called on the Federal Trade Commission (FTC) today to exclude health professionals from controversial new regulation intended to combat identity theft. A letter sent to FTC Chairman Jon Leibowitz by leaders of the American Dental Association (ADA), American Medical Association (AMA), American Osteopathic Association (AOA) and American Veterinary Medical Association (AVMA) is the latest challenge to the so-called “red flags” rule. The FTC’s interpretation of the regulation imposes a mandate on health professionals for detecting and responding to identity theft. The organizations asked the FTC to make it clear that the rule will not apply to their members given the result of recent litigation brought by the American Bar Association against the FTC. In that case, the U.S. District Court for the District of Columbia ruled that lawyers should be excluded from the requirements imposed by the red flags rule. The court decision follows wide criticism that the FTC’s overly broad interpretation of the Fair and Accurate Credit Transactions Act of 2003 (FACT) led the commission to create a rule that oversteps its authority. In response to these concerns, the FTC postponed the rule’s effective date to June 1, but it has never changed the position that the rule will apply to health professionals. For a copy of the joint letter to the FTC, please visit the AMA website at: http://www.ama-assn.org/ama1/pub/upload/mm/399/ftc-letter-red-flags.pdf

Call for Comment: Continuing Medical Education

§ http://www.accme.org/dir_docs/doc_upload/5aa47c6d-3e95-48c9-916b-18bbaa080f86_uploaddocument.htm

Payment for Claims to be Held Until Jan 15

Annual Participation Enrollment Period Extended

In the last weeks of 2009, Congress acted to avert the 21.2% Medicare physician payment cut and on December 19, the President signed into law the Department of Defense Appropriations Bill (H.R. 3326) which will stop the cuts until March 1, 2010. Other changes reflected in the 2010 Medicare Physician Fee Schedule final rule will still take effect on January 1, 2010 and may have a slight impact on the conversion factor used for the first two months of 2010. For more information visit www.lamedicare.com/provider/viewarticle.aspx?articleid=8034. Consequently, CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010, therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010. The effective date for any Participation status change during the extension, however, remains January 1, 2010, and will be in force for the entire year.

LSMS Expands Member Benefits with Venyu’s AmeriVault Backup Service

The LSMS has partnered with leading offsite data backup and recovery provider, Venyu to bring you secure patient and practice data backup through their proven AmeriVault backup service. LSMS members will receive discounts on Venyu’s competitive subscription rates. As an independent subsidiary of healthcare IT services provider, PHNS, Venyu leverages vast experience and capabilities that enable deep understanding of the needs specific to the medical field. From HIPAA compliance to military-grade security controls, Venyu’s backup solution will ensure rapid recovery of information in the event of an outage or data-loss event.

Venyu is the official backup provider of the LSMS – join the growing number of healthcare providers who depend on Venyu for reliable and secure data backup. Setup is easy with the ‘hands-on’ assistance of Venyu’s support team, there is no hardware to buy, and you can start with a 30-day trial evaluation. Call or email Andy Piner to schedule a trial or to learn more: 225-214-3800 or apiner@venyu.com.

January 8, 2010

A Word from Our President

This is my last President’s Update message, and I wish to thank all of you for the opportunity you have given me to serve as your LSMS president over the past year. Beginning with health system reform in our state and struggling with national health system reform over the last many months, it has been a busy year for LSMS. The LSMS President’s Update has attempted to keep our members informed and current on the many issues facing medicine and physicians in our state. We have received wonderful feedback and ideas from our members, and I hope that you will all continue to read this important information as Dr. Patrick Breaux assumes the presidency of the LSMS. The events of the past year have highlighted the great need for physicians to be involved in the LSMS and to have their voices heard in the public arena. Whatever the outcome of national legislation, there will be a monumental amount of work to do to properly influence the direction of health care reform in our state. Please stay involved and continue to urge our non-member colleagues to join us. The public and elected officials are looking to us for guidance on health care delivery issues. We cannot let them down. God bless you all and the happiest of New Years.

Roger D. Smith, M.D.

2010 Annual Meeting of the HOD

The 2010 Annual Meeting will be held January 29-30 at the L’auberge du Lac Casino and Golf Resort in Lake Charles. LSMS Members are encouraged to log in and access specific information regarding the House of Delegates, including guidelines for submitting and formatting resolutions. Look for Governance in the Members Only menu. The House of Delegates is the legislative and policy-making body of the LSMS and is composed of elected and special delegates and others as provided in the LSMS Bylaws. The House of Delegates transacts all business of the Society not otherwise specifically provided for in the LSMS Charter and Bylaws, elects general officers (in accordance with the Bylaws), adopts an annual budget and establishes the official policies of the Society.

Luck of the Draw!

In addition to the items offered by our event sponsors and exhibitors, meeting attendees may participate in the LSMS Luck of the Draw game for a chance to win up to $500 in cash. Five marked cards, each worth $100, will be randomly placed within decks of playing cards given to each sponsor/exhibitor. When visiting a sponsor/exhibitor’s booth, participants will have a chance to draw a playing card from the deck. The more cards you draw, the higher your chances to win!

The names of the winner(s) will be announced at approximately 11 am on Saturday, January 30, 2010. Winner must be present with a photo ID to claim prize.

National Health System Reform
The Kaiser Family Foundation has updated its interactive side-by-side health reform comparison tool to reflect the Senate bill as passed by the full Senate on Dec. 24. A separate interactive calculator helps to illustrate what assistance the uninsured would get with premiums under the House and Senate reform plans. To view the comparison, go to www.kff.org/healthreform/sidebyside.cfm. Continue to check www.LSMS.orgfor breaking news and the latest information on national health care reform.

DHH Outlines Mid-Year Reductions

On December 30, 2009, Louisiana Department of Health and Hospitals Secretary Alan Levine announced mid-year reductions in department spending of state general funds, and proposed utilization of other means of financing, in order to offset a $108 million deficit in available funding. DHH's reductions are part of an overall across the board mid-year reduction plan for each agency to help address the state's mid-year budget deficit, and is supplemental to the Department's now downward-revised mid-year expenditure deficit in the Medicaid private provider program of $46.9 million. Read the entire news release for details on mid-year cuts.

Payment for Claims to be Held Until Jan 15 Annual Participation Enrollment Period Extended

CMS Transmittal on Consultation Codes

The Centers for Medicare & Medicaid Services (CMS) has published an article pertaining to Change Request (CR) 6740, which alerts physicians and non-physician practitioners that effective January 1, 2010, the Current Procedural Terminology (CPT) consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment. Effective for services furnished on or after January 1, 2010, physicians and non-physician practitioners should code a patient evaluation and management visit with E/M codes that represents where the visit occurs and that identify the complexity of the visit performed. For more information, please view the article located at: www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdfon the CMS Web site.

LSMS Expands Member Benefits with Venyu’s AmeriVault Backup Service

December 9, 2009

National Health System Reform

Prior to the Thanksgiving holiday, the U.S. House passed its version of health system reform legislation (H.R. 3962) and the Senate voted to invoke cloture, a procedural vote that allows the full Senate to begin its debate on HR 3590. Introduced by Senate Majority Leader Harry Reid (D-Nev.), the bill is sure to be heavily debated and amended. Last week, Republicans tried to reverse cuts to the Medicare program, but failed on a vote of 58-42, drawing the support of two Democrats. Another contentious proposal passed 61-39 along party lines, in favor of requiring all insurance companies to cover breast cancer screenings for all insured women age 40 and older with no out-of-pocket costs despite an earlier, heavily-criticized federal advisory committee recommendation to defer routine mammograms until women reach the age of 50. Many more amendments are expected to be offered to the bill, so it is unlikely the bill will be passed in its current form. With the high volume of amendments being offered, a timetable for a Senate vote on the bill is not available.

The Kaiser Foundation's Side-by-Side Comparison of Major Health Care Reform Proposals has been updated.
The American Medical Association (AMA) has published a chart detailing and comparing key provisions in the House and Senate bills and how they stack up against AMA policy.

2010 Medicare Physician Payment Final Rule

The 2010 Medicare physician payment final rule was released on October 30 and will be published in the Federal Register on November 25. The rule establishes a 2010 payment update of -21.2%. A cut of this magnitude is without precedent and is due largely to the approach Congress has used in a series of short-term band-aid approaches used to stop previous cuts. The AMA is aggressively pursuing sustainable growth rate (SGR) repeal this year as part of health system reform to eliminate the threat of steep pay cuts once and for all. The rule also indicates that the 2010 Medicare Economic Index (MEI) is 1.2%. The major highlight of the rule is that it finalizes the Centers for Medicare and Medicaid Services' (CMS's) proposal to retroactively remove drugs from SGR calculations, restoring $122 billion to funding for physician services over 10 years.

Senate Bill 1776, a bill to stop the cut and change the SGR, was defeated in late October. Senator Landrieu voted for SB 1776; and Senator Vitter voted against it. Presently, the Baucus bill (HR 3590) includes only the usual one year freeze and ignores changing the SGR. The Senate will have to pass the freeze either in their health system reform bill; or stop the cut with a temporary measure; or include the freeze in the 2010 budget bill.

H1N1 Flu Update

On December 7, 2009, the Louisiana Department of Health and Hospitals (DHH) updated the status of the state's Fight the Flu campaign, announcing that 183,579 doses of H1N1 vaccine have been administered across the state. Of the 1,021,900 doses of 2009 H1N1 vaccine the state has ordered, the CDC reports that 817,000 doses of 2009 H1N1 vaccine have been shipped to Louisiana as of Thursday, December 3. As of Monday, December 7th, 1,087 providers in Louisiana have administered 183,579 doses of H1N1 vaccine, as of Monday, December 7. Get the latest news and information at www.FightTheFluLA.com.

PDR and HCNN Team Up for Patient Safety

Your complimentary copy of the 2010 Physician Desk Reference^TM (PDR) will be arriving soon. In the PDR you will notice several changes including the integration of the PDR with the Health Care Notification Network (HCNN). Louisiana State Medical Society has partnered with HCNN to ensure that FDA-required drug Alerts reach you immediately via email or fax. To continue to receive your PDR and FDA-required Alerts, please confirm your contact information on the verification form included with your 2010 PDR, or online at http://verification.pdr.net. Please be sure to note your LSMS affiliation on the PDR form. If your PDR does not arrive or to register for other PDR services, please contact PDR Network at 1-800-232-7379.

CME Opportunity - PriMed Conference in New Orleans
Pri-Med, in collaboration with the American Diabetes Association, invites you to Diabetes In Depth, a complimentary, 1-day CME program covering critical information you need to know to help improve your patients' health outcomes. At Diabetes In Depth to be held on December 18, 2009 at the Sheraton New Orleans Hotel, expert faculty will present clinically relevant practice and patient care issues in diabetes diagnosis and treatment. For detailed session and speaker information and to register, visit www.pri-med.com/ada/31NOR09A/R12 or call 866-263-2310 (Toll-free, Mon-Fri, 9 AM-8 PM EST).

2010 Annual Meeting of the HOD

Save the Date! The 2010 Annual Meeting will be held January 29-30 at the L'auberge du Lac Casino and Golf Resort in Lake Charles. LSMS Members are encouraged to log in and access specific information regarding the House of Delegates, including guidelines for submitting and formatting resolutions. Look for Governance in the Members Only menu. The House of Delegates is the legislative and policy-making body of the LSMS and is composed of elected and special delegates and others as provided in the LSMS Bylaws. The House of Delegates transacts all business of the Society not otherwise specifically provided for in the LSMS Charter and Bylaws, elects general officers (in accordance with the Bylaws), adopts an annual budget and establishes the official policies of the Society.

Health Care and Disaster Planning: Download your FREE copy today!

"Health Care and Disaster Planning: Understanding the Impact of Disasters on the Medical Community," a report summarizing research and interviews conducted with medical professionals who were on the front lines during hurricanes Katrina and Rita, is available for FREE by download at www.healthcaredisasterplanning.org. This report is unique because it focuses on the first hand experiences of the medical community, and details their recommendations for disaster and emergency planners in the medical field. The Web site features a section called, In Their Words, which are the comments and stories from physicians and facility administrators who worked on the front lines. Print copies of the book are available to members for $15; $20 for nonmembers. Please contact the Dept of Public Affairs at 222.763.8500 or publicaffairs@lsms.org to order your copy today.

November 4, 2009

National Health System Reform
Over the weekend, the GOP announced that is will offer its own bill to address health care reform. House Republican Leader John Boehner (R-Ohio) is the spokesperson for the new strategy, touting the plan as "common-sense health care reforms our nation can afford." The Republican bill has four major concepts:

let families and businesses buy health insurance across state lines;
allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do;
give states the tools to create their own innovative reforms that lower health care costs; and
end junk lawsuits that contribute to higher health care costs

The concept, according to Mr. Boehner, is to make the current system more efficient, expand coverage and control the rising costs of care. The Republicans believe the bill would expand coverage to millions of Americans, without raising taxes or mandating individuals and businesses purchase insurance.

In contrast, House Speaker Nancy Pelosi (D-California) and fellow House Democrats presented their newest version of the House health care reform bill (HR 3962) last week. In a controversial move that some say "weakens" the public option component, the new bill allows for negotiating rates with doctors and hospitals, rather than using the allowable charges and payment rates in Medicare. Additionally, provisions that allowed states to experiment with the single payer option were removed because of heavy opposition from progressive House members who favor of a strong public option. The public option is sure to spark heated debate in the House, which is scheduled to begin this week.

Senate Majority Leader Harry Reid has made it clear that he is planning to bring the Senate bill to the floor for debate later this month, but he must get 60 votes to open the debate. With the addition of a public option to the Senate bill, Senator Reid's (D-Nevada) support is shaky at best. When the full Senate and House both pass bills, then they will hold conference meetings to combine their versions and work out differences.

Read the new 1,990 page House bill here: http://docs.house.gov/rules/health/111_ahcaa.pdf

LA Medicaid Over Budget by $308 Million
LA Department of Health and Hospitals Secretary Alan Levine announced that the state health agency is projecting a $308 million shortfall in Medicaid funding for this fiscal year. As required by state law, Secretary Levine made his mid-year report the Joint Legislative Committee on the Budget this week, along with his recommendations on how to bring spending back in line. According to Levine, the higher spending is largely due to increased medical billings associated with the H1N1 flu virus, and he does not expect it will be recurring. Higher than anticipated Medicaid enrollment and usage, as well as higher pharmacy spending, also have contributed to the problem. DHH plans to use some federal stimulus dollars and other one-time money to close the gap. Private providers (physicians, hospitals, pharmacists and other private health-care providers) will not be cut this year, however public providers (health units and mental hospitals) will see some reductions.

2010 Medicare Physician Payment Final Rule
The 2010 Medicare physician payment final rule was released on October 30 and will be published in the Federal Register on November 25. The rule establishes a 2010 payment update of -21.2%. A cut of this magnitude is without precedent and is due largely to the approach Congress has used in a series of short-term band-aid approaches used to stop previous cuts. The AMA is aggressively pursuing sustainable growth rate (SGR) repeal this year as part of health system reform to eliminate the threat of steep pay cuts once and for all. The rule also indicates that the 2010 Medicare Economic Index (MEI) is 1.2%. The major highlight of the rule is that it finalizes the Centers for Medicare and Medicaid Services' (CMS's) proposal to retroactively remove drugs from SGR calculations, restoring $122 billion to funding for physician services over 10 years.

H1N1 Flu Update
The H1N1 vaccine has arrived in the state, but in short supply. DHH ordered 233,100 doses, and is expecting more shipments every five to 10 days, according to DHH Director of Communications Rene Milligan. As of Oct. 21, DHH reported that only 14,843 doses of H1N1 vaccine were administered. Pregnant women, children, people with chronic illness, medical providers and people who care for children below six months of age are the primary recipients of the vaccine. The H1N1 flu is responsible for 24 deaths in Louisiana as of Oct 27th. DHH has launched a Web site www.FightTheFluLA.com, with the intention of mapping locations where the vaccine will be available across the state, when there is enough vaccine available for the general population.

CME Opportunity -- PriMed Conference in New Orleans
Did you know only 57% of patients are achieving the American Diabetes Association A1C goal of <7%? (Hoerger TJ, et al. Diabetes Care. 2008;31:81-86.) It is crucial for you to stay up-to-date on the comorbidities and risk factors associated with diabetes. Pri-Med, in collaboration with the American Diabetes Association, invites you to Diabetes In Depth, a complimentary, 1-day CME program covering critical information you need to know to help improve your patients' health outcomes. At Diabetes In Depth to be held on December 18, 2009 at the Sheraton New Orleans Hotel, expert faculty will present clinically relevant practice and patient care issues in diabetes diagnosis and treatment. Pri-Med designates this educational activity for a maximum of 9 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. National experts speaking in New Orleans include:

Lawrence Blonde, MD, FACP, FACE, Director, Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
Laurence Kennedy, FRCP, MD, Chairman, Department of Endocrinology, Diabetes, and Metabolism, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
Yehuda Handelsman, MD, FACP, FACE, Medical Director, Metabolic Institute of America; Vice President, American Association of Clinical Endocrinologists, Chair & Program Director, 7th World Congress on Insulin Resistance, San Francisco, CA; Chair, Diabetes Council- AACE, Chair, International Committee for Insulin Resistance, Tarzana, CA

Register today. Learn more. For detailed session and speaker information and to register, visit www.pri-med.com/ada/31NOR09A/R12 or call 866-263-2310 (Toll-free, Mon-Fri, 9 AM-8 PM EST).

2010 Annual Meeting of the HOD
Save the Date! The 2010 Annual Meeting will be held January 29-30 at the L'auberge du Lac Casino and Golf Resort in Lake Charles. LSMS Members are encouraged to log in and access specific information regarding the House of Delegates, including guidelines for submitting and formatting resolutions. Look for Governance in the Members Only menu. The House of Delegates is the legislative and policy-making body of the LSMS and is composed of elected and special delegates and others as provided in the LSMS Bylaws. The House of Delegates transacts all business of the Society not otherwise specifically provided for in the LSMS Charter and Bylaws, elects general officers (in accordance with the Bylaws), adopts an annual budget and establishes the official policies of the Society.

Health Care and Disaster Planning: Download your FREE copy today!
"Health Care and Disaster Planning: Understanding the Impact of Disasters on the Medical Community," a report summarizing research and interviews conducted with medical professionals who were on the front lines during hurricanes Katrina and Rita, is available for FREE by download at www.healthcaredisasterplanning.org. This report is unique because it focuses on the first hand experiences of the medical community, and details their recommendations for disaster and emergency planners in the medical field. The Web site features a section called, In Their Words, which are the comments and stories from physicians and facility administrators who worked on the front lines. Print copies of the book are available to members for $15; $20 for nonmembers. Please contact the Dept of Public Affairs at 222.763.8500 or publicaffairs@lsms.org to order your copy today.

October 9, 2009

LSMS Leaders Hold Strategic Planning Sessions on Medical Malpractice, National Health Care Reform

On September 25-26, 2009, following its quarterly meeting the LSMS Board of Governors held two special planning sessions to discuss the status of Act 817/medical malpractice legislation and national health system reform. The purpose of the sessions was to develop a more clear understanding of the current environment and develop strategies for communicating the LSMS' position on these important issues.

During the session on medical malpractice the Board received a report on the status of the Patients Compensation Fund (PCF) and an update on meetings of a Medical Malpractice legislation coalition of health care providers, plaintiff attorneys, insurance entities and the PCF that was organized during the past legislative session by Representative John Bell Edwards of Amite. In addition, the Board heard from Elliott Baker, a noted medical malpractice and constitution attorney, on important cases involving the caps under Act 817 that are now before the Louisiana Supreme Court. The major issue discussed was possible increases in the caps under the Act and the cost impact on the health care providers of the state. After lengthy discussion the Board voted to have an LSMS ad hoc committee continue to monitor the meetings of the Legislative Ad Hoc coalition and submit recommendations to the Board at its December meeting on policy and or positions to be presented at the 2010 Annual Meeting of the House of Delegates.

On Saturday September 26th the Board and other LSMS leaders heard from Ed Haislmaier, a senior fellow at The Heritage Foundation, on current legislation in Congress and from LSMS President Dr. Roger Smith, Dr. Patrick Breaux, LSMS President-Elect and LSMS Past President Dr. Mike Ellis on current LSMS polices dealing with major areas of reform legislation. Addressing the session at lunch was Dr. William Cassidy, Congressman for Louisiana's Sixth Congressional District. Dr. Cassidy talked about the politics surrounding health system reform since Congress returned from their summer recess. Over a period of two and a half hours the Board and attendees discussed several aspects of reform and changes being discussed by both congressional chambers. Several approaches were discussed regarding the position of the LSMS on legislation as it progresses through Congress during the remainder of the year. The Board approved a motion for the President to appoint a small ad hoc committee from those attending the session to craft an LSMS message and communications plan, working with the LSMS Department of Public Affairs, to respond to development of legislation in the House and Senate.

Read LSMS' Concerns Regarding Current Legislation to Bring About Health System Reform

People on the Move

§ Dr. Rodney Wise is the new Medical Director for the Louisiana Medicaid Program under the Louisiana Department of Health and Hospitals (DHH). http://www.dhh.louisiana.gov/news.asp?ID=1&Detail=1539

§ Tony Keck has been appointed as DHH Deputy Secretary (see related story below); and

§ Shannon Robshaw has resigned as executive director of the Louisiana Health Care Quality Forum because of her husband's recent appointment as DHH Deputy Secretary.

Physicians Encouraged to Review Humana Contracts

The physician protections of the Humana multidistrict litigation class-action settlement agreement end Oct. 19. The termination of the Humana settlement agreement means that Humana no longer has to comply with its settlement terms. Physicians are encouraged to review their contract and contact their Humana provider representative to determine how the upcoming settlement termination will affect their business relationship with the health insurer. For more information, view the AMA resource about how the Humana settlement agreement helps physician practices; or visit www.ama-assn.org/go/settlements to view the AMA's Web page devoted to health insurer settlements.

H1N1 (Swine Flu) - AMA Announces News CPT Codes

With both seasonal influenza and H1N1 influenza circulating this flu season, the AMA expedited the publication of a new code specific to vaccine administration and revised existing code 90663 to include the H1N1 vaccine. The new Current Procedural Terminology (CPT®) code issued by the AMA will streamline the reporting and reimbursement procedure for physicians and health care providers who are expected to administer nearly 200 million doses of the H1N1 vaccine in the United States. The codes will also help to efficiently report and track immunization and counseling services related to the H1N1 vaccine throughout the health care system. Read the entire AMA news release.

§ www.flula.com - DHH has published a web site dedicated to the latest news and information on the H1N1 Flu (Swine Flu). Physicians are encouraged to review the online training course and stay up to date by reading the weekly influenza update. The site also has links to testing protocols and CDC guidance for physicians.

§ UnitedHealthcareOnline H1N1 Flu Resources - UnitedHealthcare's web page has information for physicians, including billing guidance and links to the AMA and CDC H1N1 informational web sites.

FREE Conference: Strategies for Financing and Adopting an Electronic Health Record

Thursday, November 5, 2009 from 10:00 AM to 2:30 PM

Pennington Biomedical Research Center - 6400 Perkins Road, Baton Rouge, LA

The Louisiana Health Care Quality Forum (LHCQF) will host an educational conference about purchasing Electronic Health Record (EHR) systems to take advantage of current favorable reimbursement for early adopters. The goals for the conference are: 1) to educate health care providers about the reimbursement benefits for early adoption and penalties for delaying adoption for Medicare and Medicaid providers as well as those who are not currently serving Medicare and Medicaid populations, 2) to explain EHR "meaningful use" requirements, 3) to provide information on EHR vendor selection, 4) to describe how to pay for a new

EHR or the upgrading of an existing system, and 5) to present different available financing opportunities. Participation in the EHR Adoption Conference is free. All health care providers, their IT support staff, and their business office staff are encouraged to attend. Register by Thursday, October 29th at www.LHCQF.org.

Health Care and Disaster Planning: LSMS Book Release

The Louisiana State Medical Society Educational & Research Foundation (LSMS ERF) is pleased to announce the release of Health Care and Disaster Planning: Understanding the Impact of Disasters on the Medical Community, a report summarizing research and interviews conducted with medical professionals who were on the front lines during hurricanes Katrina and Rita. Last week, complimentary copies of the book were mailed to governor's offices, emergency preparedness offices and state medical societies across the nation. A Web site, www.healthcaredisasterplanning.org, has been launched to provide free and immediate access to the public. This report is unique because it focuses on the first hand experiences of the medical community, and details their recommendations for disaster and emergency planners in the medical field. The Web site features a section called, In Their Words, which are the comments and stories from physicians and facility administrators who worked on the front lines. Print copies of the book are available to members for $15; $20 for nonmembers. Please contact the Dept of Public Affairs at 222.763.8500 or publicaffairs@lsms.org to order your copy today.

Call for entries - LSMS Honors Excellence in Health Care Journalism

Each year the LSMS recognizes individuals whose journalistic efforts contributed to a better understanding of medicine and health care in Louisiana. Entries will be judged on the basis of accuracy, overall quality, public interest, and educational value in the fields of medicine and health care in Louisiana. A cash award of $500 and an engraved plaque are presented to winners in each of three categories: print, radio, and television. Deadline for submissions is Wed., October 28, 2009. Read more: Call for Entries and Entry Form or review 2008 Media Awards winners.

September 15, 2009

LSMS Leaders Meet with Congressional Delegation to Discuss National Health Care Reform

H.R. 3200 - America's Affordable Health Choices Act 2009
With the energy level increasing at Town Hall meetings, the response from people across the country is resonating all the way to the White House. Over the past month, the LSMS has met with members of the Louisiana Congressional Delegation to voice concerns about proposed legislation and the speed at which reform legislation is targeted for passage. Our message is slow down and Do It Right.

"The efforts of LSMS members and their families are forcing our elected officials to take notice of the public's response to health system reform and to consider the ramifications of their proposals," said LSMS President Dr. Roger Smith.

The LSMS has received responses from many members voicing their opinions about the national health care system reform effort. These physicians attended town hall meetings, contacted their Congressman and Senators, and wrote letters to the editor. Additionally, component societies have been active in responding to local media including their own position statements. These concerted efforts send the message that health care system reform must be done for the right reasons, and in the right way to bring about fiscally responsible changes needed to improve the system.

LSMS Key Points Concerning the President's Proposed Plan

LSMS Board of Governors to Hold Strategic Planning Sessions

September 25-26, 2009 - The LSMS Board of Governors will hold its quarterly board meeting on Friday, September 25th. The afternoon portion of the board meeting will be devoted to strategic planning on medical malpractice reforms and possible changes to Act 817 that are anticipated to be taken up during the 2010 Regular Session of the Louisiana Legislature. On Saturday, September 26th, the board will engage in a planning session to develop strategies on national health system reform for the remainder of this session of Congress.

LSMS Survey Says - Medicaid Cuts Will Impact Patients' Access to Care

August 31, 2009 - The LSMS released the results of a recent survey of LSMS members, revealing that two-thirds of doctors responding would be unable to accept new Medicaid patients or stop treating Medicaid patients altogether as a result of the recent cuts announced by the Louisiana Department of Health and Hospitals of approximately 10 percent in physician reimbursement rates for Medicaid in fiscal year 2009-10. Read the entire LSMS media release.

"Even before the lingering effects of Hurricanes Katrina and Rita, access to care was an issue in Louisiana," explained Dr. Roger D. Smith, LSMS President. "This survey shows that these new cuts will exacerbate a long-standing problem. Medicaid patients will have increased difficulty in finding or keeping a physician, and they will become even more dependent on the already overburdened safety net system. Even more patients will begin to seek care in hospital emergency rooms, driving up more expensive hospital costs while the hospitals are receiving less Medicaid reimbursement due to the recent cuts."

"These budget cuts will have a devastating impact on physicians who treat Medicaid patients," Dr. Vincent Culotta, chair of the LSMS Council on Legislation, said. "But this is the tip of the iceberg in light of future program cuts. Looming even larger is the financial viability of the Medicaid program. DHH Secretary Alan Levine has been emphasizing for months the upcoming significant loss of critical funding. The scheduled reduction of federal Medicaid matching funds, loss of some federal disproportionate share hospital allocations and the expiration of federal stimulus money will severely cripple the state's Medicaid program."

Read DHH Emergency Rules, effective August 4, 2009

HITECH Act - Stimulus Funding for Providers

On Feb. 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 (Recovery Act), a critical measure to stimulate the economy. Among other provisions, the new law provides major opportunities for the Department of Health and Human Services (DHHS), its partner agencies, and the States to improve the nation's health care through health information technology (HIT) by promoting the meaningful use of electronic health records (EHR) via incentives. The HIT provisions of the Recovery Act are found primarily in Title XIII, Division A, Health Information Technology, and in Title IV of Division B, Medicare and Medicaid Health Information Technology. These titles together are cited as the Health Information Technology for Economic and Clinical Health Act or the HITECH Act. Under Title IV, funding is available to certain eligible professionals (EPs) and hospitals. Funds will be distributed through Medicare and Medicaid incentive payments to EPs, physicians, and hospitals who are "meaningful EHR users." Find out more by reading the October issue of Capsules, or visit the CMS web site. For a copy of the full bill, go to: http://www.hhs.gov/recovery/overview/index.html.

LA Health Care Quality Forum - Bridging the Gap Between the HITECH Act and Providers

Deadline September 25th - The LHCQF is conducting a survey to gather necessary information to inform all of its activities geared toward the goal of receiving funding to support providers in Louisiana in meeting the requirements of the HITECH Act and becoming eligible to receive incentive payments by becoming meaningful users of HIT, and to avoid penalties for not doing so. The current survey is for ambulatory health care facilities. Someone who is familiar with the characteristics of the health care facility, including the types of patients seen, the services provided, and the technology used in the facility, should complete the survey. To complete the survey, please go use the link below. If you do not have Internet access but would like to complete the survey, please call (225) 334-9299.

Take the survey: http://www.surveymonkey.com/s.aspx?sm=X49GAwqaLbHIuGK_2bkOZKJQ_3d_3d

H1N1 (Swine Flu) - Registration opens for vaccine providers

Physicians and other health care providers should have received a letter from DHH regarding H1N1 vaccine distribution last week. The U.S. government will provide states with federally-funded novel H1N1 vaccine and supplies, however the vaccine is not available through the routine vaccine purchasing and distribution mechanisms. Louisiana providers must receive the vaccine from the Louisiana Office of Public Health (OPH) - Immunization Program. In order to receive state/federally-supplied H1N1 vaccine, you must register online. DHH has published a web site dedicated to the latest news and information on the H1N1 Flu (Swine Flu), www.flula.com. Physicians are encouraged to review the online training course and stay up to date by reading the weekly influenza update. The site also has links to testing protocols and CDC guidance for physicians.

LSMS Career Center - A Can't Miss Opportunity for Job Seekers AND Employers

The perfect job. The perfect candidate. Make the perfect match with the LSMS Career Center.
Job Seekers - Find the best physician opportunities, in the state and nationwide by visiting the LSMS Career Center. Employers - List your open positions with the LSMS Career Center to find the best candidate, locally and nationwide!

August 6, 2009

National Health Care Reform
H.R. 3200 - "America's Affordable Health Choices Act 2009"

Last week, House Speaker Pelosi and Senate Majority Leader Reid reiterated that both chambers would not have a floor vote on reform legislation before the summer recess. Since that announcement, committees of jurisdiction have been rushing to complete markup of their versions of a reform bill. The House Energy and Commerce Committee, the last of the House committees working on legislation, voted on a final package of amendments on Friday evening(July 31) concluding its markup of HR 3200 However, Senate conferees announced last week they would not complete their markup before leaving on summer recess August 7th. Much work is left to be done on resolution of each chamber's legislation upon their return. Speaker Pelosi said this week she wants a bill sent to the House floor no later than September 15.

The LSMS believes the process of writing reform legislation must slow down in order for it to be done the right way and have a reasonable chance to succeed. The LSMS will be carrying this message to the members of Louisiana's Congressional Delegation in the coming weeks. However, the pressure on Congress to do it right must come from you. Add Your voice to those across the nation to change legislation reforming our health care system. Using the key points below, contact your Congressman and Senators and voice your position on reform legislation.

Key Points Concerning H.R. 3200 Letter to Louisiana Congressional Delegation

The LSMS also urges you to make your voice known locally. In recent weeks, more newspapers across our state are carrying letters to the editor from individual physicians who are stating their opinion on health care reform. Consider this as another way to bring your experience and perspective as a physician to the public on the impact of health system reform.

Understanding the Issues

To keep members informed national health care reform, every Friday the LSMS will email its members on the status of current health care reform legislation. This weekly update will include a summary of at least one key component of the reform proposal, as excerpted from the Kaiser Foundation's Health Care Reform Proposals document below.

Example:

Individual Mandate

H.R. 3200 requires all individuals to have "acceptable health coverage". Those without coverage pay a penalty of 2.5% of modified adjusted gross income up to the cost of the average national premium for self-only or family coverage under a basic plan in the Health Insurance Exchange. Exceptions granted for dependents, religious objections, and financial hardship.

Note from the LSMS: the new Health Insurance Exchange will determine the criteria for "acceptable health coverage".

Resource

Health Care Reform Proposals, Kaiser Foundation

The Kaiser Family Foundation, a trusted source of health care information, has published a side by side comparison of the major proposals being considered in Congress, including H.R. 3200. This document compares major components of these proposals and provides detailed descriptions of provisions. It will be regularly updated to reflect changes in the proposals and to incorporate major new proposals as they are announced.

DHH Announces Medicaid Cuts to Physicians

As a result of a budgetary shortfall, the Department of Health and Hospitals (DHH) Bureau of Health Services Financing has adjusted reimbursement rates paid for physician services to avoid a budget deficit in the medical assistance programs. It is estimated that implementation of this Emergency Rule will reduce payments to physicians through the Medicaid Program by approximately $18,455,238 for state fiscal year 2009-2010.

Effective for dates of service on or after August 4, 2009, the reimbursement for all physician services rendered to recipients 16 years of age or older shall be reduced to 80 percent of the 2009 Louisiana Medicare Region 99 allowable or billed charges whichever is the lesser amount. The following physician services are excluded from the rate adjustment: a. preventive medicine evaluation and management; b. immunizations; c. family planning services; and d. select orthopedic reparative services.

Read DHH Emergency Rules, effective August 4, 2009
Interested persons may submit written comments to Jerry Phillips, Bureau of Health Services Financing, P.O. Box 91030, Baton Rouge, LA, 70821-9030.

LSMS Launches Career Center

The perfect job. The perfect candidate. Make the perfect match with the LSMS Career Center.
The Louisiana State Medical Society is pleased to announce the launch of the LSMS Career Center, a new online resource designed to help you find the best physician opportunities, in the state and nationwide. The new LSMS Career Center will make its debut this week on www.LSMS.org, and will provide you:

Job search control - Quickly and easily find relevant industry job listings and sign up for automatic email notification of new jobs that match your criteria.
Easy job application - Apply online and create a password-protected account for managing your job search.
FREE and confidential resume posting - Make your resume available to employers in the industry, confidentially if you choose.
Saved jobs capability - Save up to 100 jobs to a folder in your account so you come back to apply when you are ready.

Don't miss this unique opportunity to connect with the industry's best employers! Visit www.LSMS.org today, and click on the LSMS Career Center logo in the left sidebar.

Red Flags Rule - Implementation Delayed Again

The Federal Trade Commission (FTC) announced on July 29, 2009, that--for a third time--it has pushed back enforcement of the anti-fraud regulations until Nov. 1, a full year after it was first scheduled to take effect. To assist small businesses and other entities, the FTC staff will redouble its efforts to educate them about compliance with the "Red Flags" Rule and ease compliance by providing additional resources and guidance to clarify whether businesses are covered by the Rule and what they must do to comply. To give creditors and financial institutions more time to review this guidance and develop and implement written Identity Theft Prevention Programs, the FTC will further delay enforcement of the Rule until November 1, 2009.