Usually I am accused of relaying “doom and gloom” messages about the business side of physician practices, especially with regard to Emergency Medicine.  Later in this newsletter CMS changes are revealed in which it is estimated that there will be a 4% increase in reimbursement from Medicare next year.  To the extent that many managed care contracts are indexed to Medicare rates as a percent, this increase may have a magnified positive effect on revenue for physicians.  In an era of economic bad news and considering that during this past summer congress was considering a 10.6% decrease in reimbursement, this is especially good news. 

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The 2009 Medicare Physician Fee Schedule was published in the Federal Register on 11/19/08.

ACEP estimates Emergency Physicians’ will receive a 4% average increase. This comes about because provisions in MIPPA that called for a 1.1% raise in 2009 also directed CMS to change how the fee schedule adjustment is made. This budget neutrality adjustment often negates the increases for Emergency Physicians because of the undervalued cost value due to the AMA cost determination for “practice expenses” for emergency physicians. This year the Congressional direction to give greater consideration to the physician work value, combined with the increase in physician work values of the E/M codes from 2007 will result in a gain for most Emergency Medicine codes. 

Please see the 2009 schedule below:

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Our Role and the Economy

          I read an article today entitled “Now is the Time to be Afraid”.  There is no way to determine whether the article’s claims are well founded and no, I have no idea what the markets will do tomorrow.  In fact, I am somewhat helpless in that I have no control over it at all. 
          What I can control is how MedaPhase responds to the current times.  On Wednesday morning of last week I called all of our employees together and gave a ‘let’s not panic’ speech.  Things have definitely gotten worse since then. According to the article I read, it is time to panic.  Well, I still do not believe it.  Somehow, sometime this nosedive will level off and begin to rise again before it crashes.  The sky is not falling and the world is not going to come to an end anytime soon. This is my belief and I am sticking to it. 

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Understanding that documentation feedback is one of the most important aspects of our services, MedaPhase has implemented a new process for getting our physicians feedback in a timely, consistent manner.

Quarterly audits are being performed for each physician.  At the end of every quarter, 10 charts are selected for physician feedback.  In most cases, MedaPhase will include charts that have been

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Across the board, provider documentation reviews show a similar trend:  when it comes to deficiencies, most are identified in the History element of E/M documentation.  The History element includes the History of Present Illness (HPI), Review of Systems (ROS), and Past, Family and Social History (PFSH).  In order to support a high level of service (ED-99285), all three elements of History must be documented comprehensively. 

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The 2009 Texas Legislature will again deal with numerous healthcare issues, many of which were unresolved in the 2007 session.  One of the thorniest issues concerns the lack of health plan network adequacy which results in patients receiving services from “out of network” physicians and then receiving “balance-bills” for the portion of the physicians’ charges which are not paid by the health plan.  This issue has been particularly troublesome for hospital-based physicians when the hospital is contracted with the health plan but the physicians are not contracted, usually due to unrealistically low reimbursement rates offered by the health plans.

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On the first day of one of my graduate courses in college (many years ago) we spent the entire class period defining communication.  By the end of the class we settled on defining communication as the creation of understanding.  With that premise in mind we spent the rest of the semester looking at the barriers to complete understanding between people within their own organizations and outside of their own organizations.  Often leadership mistakenly assumes that a one-way expression of facts or thoughts in voice commands, memos or e-mails is communication.  However, to create understanding among people within an organization or between people in other groups takes both senders and receivers.  The sender encodes a message through the selection of words from a particular language.  The receiver decodes the message in order to understand the message the sender is trying to get across.  Finally, to make the communication loop complete there should be feedback demonstrating that the receiver “got it”.

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If you need to contact one of these employees, please dial (210) 692-0424 and the extension number, or if located out of Bexar County, Texas, please dial (888) 826-9212 and then the extension.

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     There is still time to contact your US Congressmen and US Senators regarding the Medicare Physician Fee Schedule for the last half of 2008 and for the year of 2009,  As we all know, if Congress does not act, on July 1, 2008 the Medicare Physician Fee Schedule will decrease by 10.6%.  Now is the time to make contact by e-mail, phone or letter or even personal visit to a Representative’s local of Washington, D.C. office to urge you legislators to stop the draconian fee cut.

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The following article recently came out from Leah S. Cohen, a MGMA Government Affairs Representative:

The Centers for Medicare and Medicaid Services (CMS) May 16 announced that beginning Jan. 1, 2009, it will launch a three-year Acute Care Episode (ACE) demonstration project that will include bundling Medicare payments to hospitals and physicians into a single payment.

The demonstration is limited to applicants from Texas, Oklahoma, New Mexico, and Colorado. CMS will competitively award only one ACE demonstration site per market area (defined as a metropolitan core-based statistical area, or the aggregate of rural areas within a state) during the first year of the demonstration, but plans to expand the program and award multiple providers within a market area in the following two years.

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Early in my career I worked for a company that displayed great pride in the “esprit de corps” among its leadership.  Their common slogan was “We do not have problems at our company; we have only opportunities to demonstrate our leadership ability!”  This year MedaPhase’s leadership team has had such opportunities as well.  In an effort to create greater efficiencies and control cost, we have restructured jobs, office locations and switched to a new computer system.  Although I am pleased with our progress overall, it has not been without some challenges.  With every new challenge, however, came a corresponding new learning opportunity.  I am extremely grateful for the team of people in our organization that have demonstrated great responsiveness and creativity in developing ways of overcoming obstacles along the way.

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ED physicians can provide a tremendous amount of care when a patient presents with a fracture or dislocation.  In those cases, there are several potential codes that may be utilized, depending on the type of fracture/dislocation and the care that is given.  Documentation of that care is vital to ensure minimal liability risk and proper reimbursement.  In most cases, there will be one of three scenarios:

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New TrailBlazer (Texas, Oklahoma, New Mexico and Colorado Medicare Administrative Contractor) Evaluation and Management “Coding and Documentation Reference Guide” (Audit Tool) is official and on the TrailBlazer website as of Feb. 27, 2008.

http://www.trailblazerhealth.com/partb/downloads/empocketref.pdf

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While some of the largest states Florida, Texas, and California are in different levels of state regulation over balance billing, the state of New York is now weighing in with the attorney general Andrew Cuomo’s investigation and potential suit against UnitedHealth Group. United is one of the largest medical insurers and the largest in New York. Cuomo is also currently investigating Aetna, Cigna and Empire BlueCross/BlueShield.

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The old adage that there is nothing constant but change is certainly true of MedaPhase, Inc. today.  On January 1^st of this year we began using a new billing software called AdvancedMD.   Gradually phasing out the use of our other two systems we are currently working from three separate software databases simultaneously.  Follow-up of accounts receivable for dates of service prior to January 1 is being done in the former systems in order to ensure continuity of collection processes on each individual account level.  Accurate reporting requires the combining of two separate databases and then reconciling these totals to the actual bank deposits.  At the end of another three to four months the few active accounts on each system will be loaded into AdvancedMD for further action. The inactive accounts will be archived or sent to an outside collection agency as appropriate.  This is only one stage of our metamorphoses.

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