CMS Release of Physician Payment Data

Today, CMS released 2012 Medicare payment data on virtually all physicians to the public.  As recently as January CMS indicated that patient requests under the Freedom of Information Act would be reviewed and released on a case-by-case basis. This massive release is without precedent. The release was done without the opportunity  to review the data for accuracy. MSNJ is disappointed that CMS did not allow time for this review which is conventional for other CMS programs that report data. We are also disappointed that the raw data has been released without any context that would inform the public’s evaluation of the data.

MSNJ is in favor of fee and payment transparency. We urge patients to become more familiar with the particular costs that may be included in the reported payments as well as the costs incurred by physicians to provide quality services.  We urge patients not to jump to conclusions about total payments without giving consideration to the type and quantity of services provided. We believe that many patients will be surprised to see how little physicians are reimbursed for many of the services that they provide. Patients with specific questions or concerns about the payment data are encouraged to speak directly with their physician.

Read nine reasons that the raw data released by CMS may be misleading.

Honoring the Dedication of Physicians on National Doctor’s Day, March 30, 2014

You or a family member has just gotten a worrisome medical diagnosis and you need help. We all know the feeling that may accompany confusing medical news – the anxiety, the worry. You need information, guidance and, most importantly, you need understanding. In difficult times, and routinely on a daily basis, the physician is the source of knowledge and comfort for patients, families and communities. Doctors dedicate themselves to caring for patients 24 hours-a-day, seven days-a-week, 365 days-a-year. On March 30, as we celebrate National Doctor’s Day, let us acknowledge the achievements, sacrifice and service embodied by physicians.

Entrance into the medical profession is a privilege and an honor. The rigor and thoroughness of the education and training required for medical doctors is like no other profession. Years of medical school, an internship, a residency and possibly fellowship training are just the beginning of a lifelong commitment to learning and quality patient care. The trust between patient and physician is a time-honored bond that, through all technological advances, still remains the foundation on which our healthcare system is based. While healthcare is now provided in a multitude of settings – from hospitals to clinics to outpatient facilities and now computer diagnostics – let us never forget that it is a physician, or a team of professionals led by a physician, who is actually caring for each patient.

As an obstetrician-gynecologist in practice since 1987, I have had the privilege of delivering thousands of babies and caring for many women and families in Bergen County. I have also had the pleasure of working collaboratively with physician colleagues and many allied health professionals. We are all on the same mission – to provide the best health care to our patients each and every day. Sometimes this means deciphering a complicated diagnosis, while other times it means going to bat for a patient with an insurance company.

Whatever the situation, I know that physicians throughout New Jersey strive every day to provide what their patients need. Whether it is caring for a woman in labor in the middle of the night, treating a medical emergency or even responding to an accident or disaster, physicians always answer the call and rarely seek acknowledgement for their efforts. Doctors do their job every day simply because that is what they were trained to do and what they feel compelled to do – nothing less than fulfilling their promise to their patients, which is simply to care for them.

This year, in recognition of National Doctor’s Day, I am suggesting something we can all do to honor the physicians of New Jersey. This week, pick up the phone and schedule your annual checkup. Follow through with all your doctor’s instructions. Take your medication, exercise more and eat wisely and make good choices. Help your doctor help you to be your healthiest and, if you get the chance, simply say, “thanks, Doc, for all you do every day”.

Ruth Schulze, M.D.
221st President
Medical Society of New Jersey

Hold on Medicare Claims until April 14

CMS has asked that Medicare Administrative Contractors (MACs) hold claims from April 1, 2014 through April 14, 2014, in hopes that Congress will act quickly to prevent the fee cut. This only affects MPFS claims with dates of service of April 1, 2014 and later. All claims for services delivered on or before March 31, 2014 will be processed and paid under normal procedures. Read more.

Doctors’ Day 2014

Governor Christie has filed a resolution passed by both houses of the Legislature institutionalizing an annual commemoration of Doctors Day in New Jersey. We are thrilled and thankful that the Administration and Legislature recognize the important contributions that physicians make. The Governor has also signed a proclamation commemorating Doctors’ Day 2014.

House Votes to Pass Bill with One Year Medicare Payment Patch, No SGR Repeal

Wednesday evening, March 26, MSNJ wrote to the New Jersey congressional delegation urging them to vote NO on a bill that would provide  another Medicare payment patch, instead of permanently repealing the SGR. Yesterday morning, MSNJ joined the AMA in a similar letter to the House opposing the “Protecting Access to Medicare Act of 2014″  and advocating that the House enact the physician payment and delivery system reform policy contained in H.R. 4015/ S. 2000, the SGR Repeal and Medicare Provider Payment Modernization Act. These bills have bipartisan support and provide a framework for sustainability for the Medicare program. The endless congressional cycle of short-term remedies that serve to support a failed policy are no longer acceptable.

Thursday, March 27, the House of Representatives debated H.R. 4302, the “Protecting Access to Medicare Act of 2014,” which would postpone the imminent 24 percent Medicare physician payment cut for 12 months.  The debate took place under suspension of the rules, meaning that a two-thirds majority would be required for the bill to pass.  At the conclusion of the debate, an objection was raised about the absence of a quorum, and the vote was suspended. 

Then, shortly after noon, the House of Representatives quickly recommended and passed H.R. 4302, the “Protecting Access to Medicare Act of 2014,” on a voice vote.

The Senate could follow suit very quickly; the process for action there is still to be determined.

Read the statement of Senate Majority Leader Harry Reid made on the floor shortly after the House vote.

MSNJ is disappointed that the House has passed a bill with yet another temporary patch instead of repealing the SGR with legislation that has bicameral and bipartisan support.  We will continue to advocate for a permanent repeal of the SGR. Read AMA’s statement.

House Votes to Pass Bill with One Year Medicare Payment Patch, No SGR Repeal

        Last night MSNJ wrote to the New Jersey congressional delegation urging them to vote NO on a bill that would provide  another Medicare payment patch, instead of repealing the SGR. This morning, MSNJ joined the AMA in a similar letter to the House opposing the “Protecting Access to Medicare Act of 2014”  and advocating that the House enact the physician payment and delivery system reform policy contained in H.R. 4015/ S. 2000, the SGR Repeal and Medicare Provider Payment Modernization Act. These bills have bipartisan support and provide a framework for sustainability for the Medicare program. The endless congressional cycle of short-term remedies that serve to support a failed policy are no longer acceptable.

       This morning, the House of Representatives debated H.R. 4302, the “Protecting Access to Medicare Act of 2014,” which would postpone the imminent 24 percent Medicare physician payment cut for 12 months.  The debate took place under suspension of the rules, meaning that a two-thirds majority would be required for the bill to pass.  At the conclusion of the debate, an objection was raised about the absence of a quorum, and the vote was suspended.

       Shortly after noon, the House of Representatives quickly passed H.R. 4302, the “Protecting Access to Medicare Act of 2014,” on a voice vote.  The bill would postpone the imminent 24 percent Medicare physician payment cut for 12 months.

        The Senate could follow suit very quickly; the process for action there is still to be determined.

        Read the statement of Senate Majority Leader Harry Reid made on the floor shortly after the House vote.

        MSNJ is disappointed that the House has passed a bill with yet another temporary patch instead of repealing the SGR with legislation that has bicameral and bipartisan support. Read AMA’s statement.

March 28 Deadline to File Claims Under Aetna Class-Action Settlement will be Extended; Court Evaluates Whether to Terminate the Settlement Agreement

Aetna is seeking to terminate a proposed class-action settlement agreement that would pay physicians and patient/subscribers $120 million. At issue is Aetna’s use of the Ingenix data base to calculate usual, customary, and reasonable fees over the past decade. The settlement was reached last year and was to be the subject of a federal district court hearing for final approval on March 18. Ahead of the hearing, Aetna notified the court it was invoking a provision of the settlement that gave the insurer the right to terminate the agreement if the settlement claims of providers and subscribers opting out of the settlement exceeded $20 million. Aetna told the court, “Based on the list of Opt-Outs provided by the Settlement Administrator to Aetna and Class Counsel, the Opt-Out levels exceed the threshold.” While the termination issue is being adjudicated Aetna has agreed to toll the time for physicians/subscribers to file their claims. Therefore, physicians who planned to file a claim by the end of this week are no longer required to meet that deadline. We will keep members apprised of developments on the termination proceedings. If the settlement is terminated, then the matter will proceed to trial. Read more. Keep up to date by visiting the Aetna UCR settlement website.

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