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Where We Stand

Legislation enacted in March, the “Protecting Access to Medicare Act of 2014,” had several implications for Chicago Medical Society (CMS) members.

While the Act averted a 24% payment cut for physicians, Congress bumped SGR repeal down the road again. The good news is that legislators on both sides of the aisle came closer than ever to a solution. CMS’ years of advocacy on SGR reform, visits to Washington, letter campaigns, and initiatives to allow physicians to privately contract with Medicare patients appear to be paying off. We will work hard for a better outcome next year.

The Act also delayed recovery auditing of short-term hospital stays until March 31, 2015. As you know, the two-midnight rule creates huge cost and quality concerns for hospitals, while adding to the documentation burden of physicians and hitting unsuspecting patients in the wallet.

Essentially, physicians are expected to determine how many nights a patient under Medicare will require in the hospital. Our clinical judgment takes a back seat to meeting arbitrary standards and documentation requirements.

In April, the American Hospital Association joined health systems in New York and Pennsylvania to file lawsuits against the U.S. Department of Health and Human Services challenging the rule. One suit maintains that it is unlawful to require physicians to certify on admission that a patient needs two midnights. A second suit contends that cutting Medicare payment to hospitals under the rule is arbitrary and unlawful. We are watching the lawsuits closely.

At this time, federal officials are considering payment alternatives for short-term hospital stays. Setting per-day rates or capping inpatient costs for some services are possible options.

Finally, the Act bought more time before the transition to the ICD-10 code set. The implementation date is now delayed until Oct. 1, 2015. While this is welcome news, most CMS members express frustration with ICD-10 and would like to see it postponed indefinitely or at least for several more years. Though ICD-10 ultimately offers benefits, CMS does not believe that physicians should bear the financial burden.

Through our education programs, CMS looks forward to preparing members to meet the demands of ICD-10, staying ahead of the curve. Training, ideally, should begin several months before the compliance deadline.

On another front, the U.S. Supreme Court will hear oral arguments this fall in a case that grapples with the issue of allowing doctors to regulate their profession through scope of practice policies when doing so interferes with competition.

The case raises issues of health care pricing, clinician shortages and antitrust. To recap: the Federal Trade Commission has accused the North Carolina Board of Dental Examiners of exercising monopoly power by forbidding dental hygienists in mall kiosks and spas from using hydrogen peroxide solutions to whiten patients’ teeth.

Some experts predict that if the Court upholds the FTC’s power to supervise state medical boards, this will result in fewer physicians or dentists participating on the boards.

FTC oversight would interfere with the long tradition of regulation of medical professions by physician boards, argues an amicus brief signed by the American Medical Association, the American Dental Association, and other groups.

CMS will be monitoring all these events closely, working every day to represent you and your profession.

Kenneth G. Busch, MD
President, Chicago Medical Society

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