This week, Larry Downs, MSNJ’s CEO and General Counsel, met with Congressman Frank Pallone to discuss a repeal of Medicare’s sustainable growth rate (SGR) which results in annual Medicare fee decreases to physicians. Congressman Pallone is a member of the Energy & Commerce Committee, and Ranking Member of the Health Subcommittee which shares jurisdiction over Medicare with the Ways & Means Committee. We are pleased to report that Congressman Pallone supports our efforts to repeal the SGR. Read MSNJ’s letter to Congressman Pallone.
MSNJ, the AMA, and organized medicine are urging Congress to seize upon this historic opportunity to use funds in the Overseas Contingency Operations (OCO) to pay for the elimination of the SGR. OCO is the discretionary fund for Afghanistan, Iraq and similar conflicts. Using OCO funding as an offset is appropriate because these conflicts are winding down significantly, but the Congressional Budget Office cannot downwardly adjust the OCO spending estimate over the next ten years until the next (FY2012) Defense Appropriations bill is passed. Read more about the rationale to use OCO funds to offset the SGR elimination which would pay for the accumulated cost of repeal. The current cost is approximately $300 billion. Congressman Pallone agrees that using OCO funds is an appropriate solution and will advocate for this. On behalf of physicians at large and our members who treat our senior population, we express sincere thanks for this support.
MSNJ also signed a letter authored by the AMA to members of the conference committee on payroll taxes, unemployment insurance and physician payments, urging it to repeal the SGR. The AMA reports that during the first public meeting on January 24 virtually all statements addressed the payment crisis and several members called for the permanent repeal as part of the final conference committee package. MSNJ will continue to meet with our delegation. Meetings with Congressmen Leonard Lance (R-NJ, 7th district) and Jon Runyan (R-NJ, 3rd district) have already been scheduled.
Information updated from previous post
The NLRB has postponed the deadline by which employers must post a notice advising employees of their rights under the National Labor Relations Act. Employers affected by the National Labor Relations Board (NLRB) rule include medical and dental practices that generate at least $250,000 in gross business volume annually. The posting deadline is now April 30, 2012, extended from January 31, 2012. The notice should be posted in a conspicuous place where other workplace rights documents are posted. Read more at NLRB’s website where the poster may be downloaded free of charge.
On January 20, 2012, MSNJ filed comments in opposition to the New Jersey Board of Chiropractors proposed regulations that would expand chiropractors’ scope of practice by allowing them to perform pre-participation screens—medical examinations of students, clearing them for sports and intramural activities. While the New Jersey Legislature previously expanded the chiropractors’ scope of practice, it specifically considered and deliberately declined to include pre-participation screens in the enabling legislation. MSNJ is confident that the legislature said what it meant and did what it said. We believe that inclusion of pre-participation screens was in error and that the Board of Chiropractors will remove this unauthorized scope of practice expansion from the regulations.
This effort is part of MSNJ’s initiative to protect the profession of medicine and ensure that any expanded scopes of practice are medically appropriate and well-defined. MSNJ will continue to monitor the rulemaking and will keep members apprised of any developments. Read MSNJ’s comments in their entirety.
MSNJ has been on the forefront of change to the Department of Banking & Insurance (DOBI) proposed regulations governing personal injury protection (PIP). This week, Commissioner Tom Considine announced that he used a new streamlined administrative procedure, signed into law by Governor Christie, that will allow DOBI to make further changes to the proposed PIP rule and fee schedule without restarting the entire rulemaking process. DOBI announced that it is addressing a number of issues, including some raised by MSNJ, in the newly revised proposals. The revised proposal will be published on February 21.
Changes include: creation of a new Hospital Outpatient Surgical Facility (HOSF) fee schedule that is separate from the Ambulatory Surgical Center (ASC) facility fee schedule, amendments of the ASC facility fee schedule fees to eliminate an over-reimbursement for implantable devices that are included in the fees, deletion of 117 fees from the Physician’s fee schedule for spinal and neurosurgical procedures to allow for further study due to their infrequency and availability of coverage, deletion of references to Workers’ Compensation Managed Care Organizations from the PIP Protocols Rule, and removal of post-employment restriction on Dispute Relation Professionals (DRP’s).
MSNJ appreciates DOBI’s collaboration with interested stakeholders and the leadership of Governor Christie to require more transparency in rulemaking. We will review the new proposal upon its release and inform members of the changes. Read the press release.
Tax, Education, Corrections Reform Highlight Governor’s Second Address
Governor Chris Christie delivered his second State of the State address after a one week delay due to the tragic death of Assembly Republican Leader Alex DeCroce. In it, Christie focused on what he dubbed the “The New Jersey Comeback” and credited bipartisan achievements such as property tax caps and public employee benefits reforms.
Moving forward, the Governor focused on Tax, Education, and Corrections reforms the Administration will be pushing in 2012. Perhaps the most ambitious, and surprising, of the three is his call for an across-the-board 10% cut in New Jersey’s income tax and restoration of the Earned Income Tax Credit for New Jersey’s poorest. Christie couched the proposal as drawing a stark contrast between New Jersey and states like New York, Connecticut, Illinois and California, who have recently increased their rates. Since this initiative will obviously have an impact on the FY2013 budget, it is likely to dominate the political discourse during the first six months of 2012.
Christie’s six point education plan came as no surprise as it’s elements have been pushed by reform advocates for years. They include: tenure reform, ending the “last in-first out” structure for layoffs, increasing pay for teaching difficult subjects or coming to failing schools, prohibiting forced placement for teachers, increasing the numbers of charter schools, and offering tax credits for families in underperforming districts.
Finally, and most important to healthcare advocates, Christies proposed sweeping changes to our penal system. While his concept of denying bail to violent offenders should be expected of a former crime fighter, his transformational plan for how New Jersey should punish non-violent drug offenders represents real, 21st Century reform that should raise more than a few eyebrows in the medical community. Under the plan, funding for addiction treatment would increase and non-violent offenders would be diverted away from prisons and into alternative treatment centers. This closely mirrors plans previously endorsed by the Medical Society and New Jersey Psychiatric Association. Like tax reform, this will impact the State’s FY2013 budget, so legislation is likely to be debated early in the session. Read the full address.
Most medical offices and healthcare facilities will be required to post a National Labor Relations Board (NLRB) poster advising employees of their rights under the National Labor Relations Act by January 31, 2012. The poster outlines employee rights to organize and prohibited conduct by employers and unions. Medical offices that generate a gross annual volume of $250,000 or more are under the jurisdiction of the NLRB and, therefore, the posting requirement applies to them. The notice should be posted in a conspicuous place where other workplace rights documents are posted. In addition, if the employer uses its website to advise employees of their rights, it must be posted there, too.
For further information about the posting, including a detailed discussion of which employers are covered by the NLRA, and what to do if a substantial share of the workplace speaks a language other than English, visit the NLRB website’s Frequently Asked Questions page where the poster may be downloaded free of charge.
The following is a message from the AMA:
The AMA GLBT Advisory Committee is soliciting nominations of qualified physicians who would be interested in serving as members of the Committee. The Committee meets at the Annual meeting in June and the Interim Meeting in November preceding the AMA House of Delegates, and focuses on addressing issues relating to gay, lesbian, bisexual and transgender (GLBT) physicians and patients. The following positions on the Committee are open for nominations:
- Two At-Large Member positions: Open to any physician member of the AMA, these positions carry a two-year term. The deadline for applying is March 1, 2012 , and interested members should should apply here or by contacting Patrick O’Keefe, GLBT Advisory Committee Staff, at firstname.lastname@example.org
- Medical Student Section (MSS) Representative: Open to members of the AMA Medical Student Section, this position carries a one-year term. The deadline for applying for this position is January 31, 2012 , and interested members should apply here or by contacting Katherine Torres-Hertz at email@example.com.
All nominees must be members of AMA. To learn more about the AMA GLBT Advisory Committee, please visit the AMA website. For further information, please contact Patrick O’Keefe, GLBT Advisory Committee Staff, at (312) 464-4978, or firstname.lastname@example.org.
While Congress delayed the 27.4% Medicare fee cut that was to have gone into effect on January 1, 2012, it is important to understand that other payment factors from the Medicare physician payment final rule will affect the 2012 fee schedule. In other words, even though the SGR-driven fee cut was averted for two months the 2012 fee schedule is not the same as the 2011 fee schedule. For example, the conversion factor was changed from $33.9764 to $34.0376. Other changes include: an extension of the floor on the work geographic practice cost index (GPCI); multiple procedure payment logic; electronic prescribing and quality reporting; and corrected relative values for certain services. Therefore, the 2011 schedule is not the schedule that will be implemented in 2012 and the currently posted 2012 schedule (that includes the 27.4% fee cut) is not the schedule that will be implemented.
Because Highmark and other carriers have not had time to implement the Medicare payment delay, passed by Congress and signed into law by President Obama on December 23, MSNJ encourages members not to submit Medicare claims until the correct payment schedule is posted. CMS estimates that carriers will have the corrected schedule posted by January 11. MSNJ will inform members when Highmark has posted the corrected schedule. Highmark previously announced a hold on claims until January 17, so the claims would not be processed in any event. Moreover, if practices submit claims with an amount less that what they are entitled to, Highmark is under no compulsion to pay the increased amount and will not reprocess these claims.
For details review AMA’s memo dated November 4 and CMS’s January 4 Federal Register correction notice to the 2012 final rule that modifies the relative values for a number of services. Also see CMS’s revised relative value file reflecting both the corrections and the legislation that delayed the 27.4% cut.
Earlier this fall, CMS announced a new Advance Payment Model for physician-based and rural Accountable Care Organizations (ACOs) participating in the Shared Savings Program. ACOs selected to participate in the Advanced Payment Model will receive upfront payments that will be recouped from the shared savings they earn. CMS will host a Special Open Door Forum to review the Advance Payment ACO Model and the application template on:
Thursday, January 5, 2012
2:30 P.M. – 4:00 P.M. ET
Special Open Door Participation Instructions:
Dial: 1-800-837-1935 & Conference ID: 39623933
Note that the Advance Payment Model is available to only two types of ACOs:
- ACOs that do not include any inpatient facilities AND have less than $50 million in total annual revenue.
- ACOs in which the only inpatient facilities are critical access hospitals and/or Medicare low-volume rural hospitals AND have less than $80 million in total annual revenue.
On or before the morning of this Special Open Door Forum, a slideshow presentation will be posted to the Advance Payment Model ACO Application Information webpage. A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website and will be accessible for downloading beginning on or around Friday, January 13, 2012.