Surgery News- July 2008

NEWS SURGERY NEWS • J U LY 2 0 0 8 Up From No. 2 Spot Payments • Hope Hinges on Grassroots Advocacy Pay Cut • from page 1 Aetna’s DAR was 26.9 days, compared with 32.6 for Cigna, and 35.7 for Coventry, which holds the No. 8 overall position. Blue Cross Blue Shield of Rhode Island had the lowest DAR for the second year in a row, at 15.8 days. Aetna had the lowest denial rate among national payers, at about 6%. The highest denial rate— 38%—was at Health Choice Arizona. The lowest denial rate overall was 3.17%, at Blue Cross Blue Shield of Rhode Island. The New York state Medicaid program came in for special criticism, because it lagged in most of the key measures. The program had the highest DAR of any payer—for the second year running—coming in at 137.3 days in 2007, compared with the national median of 35.4. New York Medicaid also had the lowest first pass resolve rate, at 57%, compared with 97% for Blue Cross Blue Shield of Ohio, the top performer in that category. According to AthenaHealth, the New York program “ranked at the bottom on the clarity of why the program rejects a medical claim.” The best overall Medicaid program, in South Carolina, had a DAR of 40 days, and a first pass resolve rate of 92%. The number two Medicaid performer, the North Carolina program, had similar rates. ■ The rankings are posted at www.athenapayerview.com. from page 1 bipartisan negotiations and pass a truly bipartisan bill which will ensure that physicians will be paid and Medicare patients will be served.” Physicians have been facing scheduled fee cuts over the last several years, but Congress has usually stepped in at the 11th hour with a temporary fix. Mostly recently, Congress voted at the end of last December to provide a 6-month reprieve on payment cuts and give physicians a 0.5% reimbursement bump. Physician leaders have been lobbying Congress for the past 6 months to pass an 18-month temporary fix that would allow them time to craft a new payment system. In the meantime, CMS officials issued the agency’s proposed 2009 Medicare Physician Fee Schedule, which contains a 5.4% cut in physician payments next year. The proposed rule also calls for changes to the PQRI. For example, the CMS is proposing that in 2009 physicians would be able to report on groups of measures related to a specific condition (see story on p. 9). The CMS is also proposing to begin accepting limited PQRI data from electronic health records next year, pending a successful test this year. The proposed rule would also require that physicians who perform diagnostic testing services meet most of the quality and performance standards established for Independent Diagnostic Testing Facilities. These include requiring a supervising physician to prove proficiency in the performance and interpretation of each diagnostic procedure and maintaining an inventory of diagnostic testing equipment. However, CMS officials are considering whether to limit the requirement to certain testing services. For example, the CMS could choose to limit the requirements to only those procedures that generally involve high-cost testing and equipment. Comments on the proposed rule will be accepted until Aug. 29; the final physician fee schedule is expected to be issued by November. ■ Group, WellPoint, Coventry Health Care, and Champus Tricare. Humana and Medicare were the top two payers in 2005; United, Wellpoint, Coventry, and Champus have more or less held steady. “We commend Aetna for their progress in improving what should be any insurer’s core competency: paying insurance claims accurately and promptly,” said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement. Aetna CEO Ronald A. Williams said in a statement, “While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area.” Rankings are calculated by scores given to performance in seven areas. If a payer paid quickly and fully, it tended to receive a higher ranking overall. Fifty-eight percent of the score came from days in accounts receivable (DAR), first pass resolve rate, and percentage of billed charges that were deemed the patient’s responsibility. Physicians have a greater collections burden when payers ask patients to foot more of the bill. There was a 19% increase in patient liability in 2006, but it only rose 0.4% in 2007. Increased availability of real-time claims adjudication has helped cut the physician collection burden, according to AthenaHealth. Physician leaders called the lack of action by Congress disappointing and predicted that it could force physicians to limit the number of Medicare patients they can see in their practices. Officials at the American College of Surgeons have vowed to put the “full arsenal” of advocacy resources into getting Congress to pass legislation that will retroactively stop the 10.6% pay cut. Thousands of ACS fellows contacted members of Congress over the past few weeks to urge action to avert the pay cut in one of the largest-ever grassroots advocacy efforts, according to the ACS. The failed legislation would also have phased out higher copayments for psychiatric services under Medicare, increased bonuses under the Physician Quality Reporting Initiative (PQRI), and delayed implementation of the Medicare competitive acquisition program for the purchase of durable medical equipment, prosthetics, orthotics, and supplies. Under the bill, the increased physician fees would have been financed in part through cuts to Medicare Advantage plans. Officials at America’s Health Insurance Plans, which represents the health insurance industry, estimated that the proposed Medicare Advantage cuts would have resulted in $13.8 billion in budget savings over the next 5 years. Republican senators who voted against consideration of the bill said sending the legislation to the president would have been useless since he had threatened to veto it if it contained cuts to Medicare Advantage plans. Instead, the senators called for more time to reach a bipartisan compromise. Sen. John Kyl (R-Ariz.) objected to the legislation, saying that it made “radical changes” in Medicare. The cuts to Medicare Advantage plans would minimize patient choice, he said, estimating that about 2 million seniors would have lost their fee-for-service plans by 2013 under the bill. “We can do better than this,” Sen. Kyl said on the floor of the Senate. “We should return to the SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Anesthesiology: Robert Morell, M.D., Clinical Associate Professor of Anesthesia, Fort Walton Beach Medical Center Bariatric: Myriam J. Curet, M.D., FACS, Professor of Surgery, Stanford University Cardiothoracic: Mark S. Allen, M.D., FACS, Professor of Surgery, Mayo Clinic Cardiothoracic: Fred A. Crawford, Jr., M.D., FACS, Chief, Division of Cardiothoracic Surgery, Medical University of South Carolina Colorectal: Robert Madoff, M.D., FACS, Professor of Surgery, University of Minnesota Endocrine Surgery: Robert Udelsman M.D., FACS, Chairman, Department of Surgery, Yale University Ethics: James W. Jones, M.D., Ph.D., FACS, Visiting Professor of Medicine and Medical Ethics, Baylor University Information Technology: Patricia L. Turner, M.D., FACS, Assistant Professor of Surgery, University of Maryland Minimally Invasive and Gastrointestinal: Gerald M. Fried, M.D., FACS, Professor of Surgery, McGill University Neurological: Hunt Batjer, M.D., FACS, Michael J. Marchese Professor, Northwestern University Obstetrics and Gynecology: William J. Hoskins, M.D., FACS, Executive Director of Surgical Activities, Memorial Sloan-Kettering Cancer Center Ophthalmology: Natalie C. Kerr, M.D., FACS, Chief, Pediatric Ophthalmology Service, University of Tennessee Orthopedic: Mark R. Belsky, M.D., FACS, Chief of Orthopedic Surgery, Newton-Wellesley Hospital Otolaryngology: Mark Weissler, M.D., FACS, J.P. Riddle Distinguished Professor, University of North Carolina Pediatric Surgery: Thomas F. Tracy, Jr., M.D., FACS, Pediatric Surgeon-in-Chief, Hasbro Children's Hospital Plastic Surgery: Linda Phillips, M.D., FACS, Truman G. Blocker Jr., M.D. Distinguished Professor, University of Texas Resident/Associate Society: Ted A. James, M.D., Assistant Professor of Surgery, University of Vermont Surgical Oncology: James P. Neifeld, M.D., FACS, Chairman, Department of Surgery, Virginia Commonwealth University Transplantation: Jeffrey Punch, M.D., FACS, Associate Professor of Surgery, University of Michigan Trauma (Burns and Mass Casualties): Steven E. Wolf, M.D., FACS, Professor of Surgery, University of Texas Trauma and Critical Care: Grace S. Rozycki, M.D., FACS, Professor of Surgery, Emory University Urology: Badrinath R. Konety, M.D., FACS, Vice Chair, Dept. of Urology, University of California at San Francisco Vascular: Linda Harris, M.D., FACS, Associate Professor of Surgery, Millard Fillmore Hospital SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Society News Group, a division of Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. POSTMASTER: Send changes of addre http://www.athenapayerview.com

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Surgery News- July 2008 Contents The 20/20 Vision: Health Reform Trauma: Airway Anchor News From the College: Jacobson Winner General Surgery: Worth the Trouble

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