Congress Dithers - Patients Suffer
Physicians and patients greatly appreciate that Congress finally took action to reverse the 21.3-percent cut in physicians’ Medicare payments that took effect June 1 and are grateful for the 2.2-percent increase that will run through November 30. However, it is widely understood that this, yet again, is nothing more than a desperate band-aid fix to a problem that only promises to exponentially multiply until meaningful action is taken.
No one is D.C. is willing to take responsibility for the impasse over Medicare’s sustainable growth rate (SGR) formula. Democrats and Republicans blame each other. The Senate blames the House, and vice versa. But no one is talking about the elderly patients and military families who will find their care threatened and their ability to see their doctors either limited or eliminated.
The Centers for Medicare and Medicaid Services (CMS) announced that the compromise recently settled by Congress will be retroactive to June 1, so claims that were processed at the reduced rate should be automatically reprocessed at the increased rate. Because the bill only fixes the problem through November, this is not a permanent fix. Just because Congress stopped today’s crisis doesn’t mean the problem is over. Best said by our sister organization down south, “Congress voted to stop the bleeding, but our Medicare system is still on life support.” Your leaders at WMS, medical societies across the country and staff at the AMA will continue to work on physician’s behalf until a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula is achieved.
2010 WMS Community Service Award Winner
The Wyoming Medical Society Community Service Award is presented each year to Wyoming’s top physician in recognition of their contributions to Wyoming communities, honoring the physician for time and personal sacrifice for the benefit of the community.
Nick Morris, MD was selected for 2010. He is a beloved member of the Powell community, a beacon of honesty and integrity. In a letter of support for Dr. Morris’ nomination, Powell physician Mike Tracy, MD wrote, “Dr. Morris is incredibly empathic and is truly the epitome of a ‘small-town’ surgeon. He has a deep commitment to his patients, and he responds with grace in all situations from trauma calls to being asked a question in the check-out line in the grocery store.”
“Nick Morris, MD is a tireless advocate for his patients and his community. The Powell medical community is fortunate to include him in our ranks,” said Robert L. Chandler, MD of Dr. Morris.
Dr. Morris has practiced medicine in Wyoming since 1991. He received his undergraduate degree from Pennsylvania State University and later completed his medical school training at Temple University Medical School in Philadelphia, PA. Dr. Morris completed his internship at Dartmouth Affiliated Hospitals in Hanover, NH and finished his medical training with a general surgery residency at Episcopal Hospital (Temple University affiliate).
Dr. Morris was recognized at the WMS Annual Meeting during the President’s Banquet Friday evening.
President Reed Shafer, MD ~ Farewell Message
I am deeply appreciative of the opportunity afforded to me over the past two years of being President of the Wyoming Medical Society. This is an old, proud organization, inclusive and important in the State of Wyoming. We are eager to help our physicians help their patients as best we see it scientifically.
We are doctors for all the right reasons. Our spouses know what we do and how much we care. We care for others often to the detriment and subjugation of ourselves and our families.
The WMS is a strong organization because of the dedication of a multitude of doctors and the wonderful, eager, and capable staff we have the good fortune to employ. Financially we are doing well. Our investments are safe, our growth is steady, our course is conservative. If you want to check the numbers let us know and we will be glad to share them with you.
Our political position statement on behalf of our members and constituents is written down in black and white. In fact, it was enclosed in the last edition of the Physician Newsletter for all to review.
These past two years have been a very interesting time. We lost our new Executive Director, Dennis Ellis, and replaced him. This was a long, daunting process and using transparency and due diligence, we had the good fortune to hire Sheila Bush. She is a gem. She is a young woman of accomplishment. WMS is very lucky to have hit a time nexus where our needs and her ability and availability have collided. I foresee a great future for WMS under the direction of this superb woman.
WMS has moved. 30 years ago, Dr. Sloan Hales came to the aid of WMS and helped ensure the organization’s financial stability and rented us space in the Hereford Building. We rented there for 32 years. This spring, we purchased a new building in downtown Cheyenne. It is on the site of the historic Cheyenne Club. It was a good financial deal. The Board had the foresight and fortitude to go get this job done and it turned out great! Come visit when you are in town. You will be welcomed.
Over the past two years, have you heard about healthcare reform? That took quite a bit of time also. We have gone through all of these major projects, as well as maintaining the day to day viability of the organization.
It is now with a deep breath of gratitude that I turn the job over to Dr. Gerrie Gardner, a true dynamo of a lady. I thank the many dedicated WMS members and the Board Officers. This organization has been ongoing for 107 years, and I now take my place at the end of a long line of distinguished, hardworking, dedicated men and women who have occupied the Presidency before me. I am proud of this association.
The message to be delivered at this time is that we, the Board of your Medical Society, are sincerely interested in being of service to you, our membership. We want your input at the community level and the individual level as to how we can increase our relevance, pertinence, inclusiveness and importance to you, our communities, our State and to the ongoing best healthcare for our patients. WMS offers a most capable staff, and a dedicated leadership Board. We have a political liaison and representation with pertinent and relevant groups in Wyoming. We represent you proudly.
Thank you for the opportunity you have afforded me over the past two years as President of WMS. I will continue to provide input as the reins of leadership are transferred to Dr. Gardner. I am happy to have been of service.
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Hidden Gems: Congress Proposes to Loosen Medicare Beneficiary Inducement Rules in Healthcare Reform Law
For years, physicians have had to comply with the Medicare and Medicaid “beneficiary inducement” rules, contained in the Civil Monetary Penalties statute. These rules prohibit any person from offering or providing any Medicare or Medicaid beneficiary any remuneration that the person knows (or should know) is likely to influence the beneficiary’s selection of a particular provider of services payable by Medicare or Medicaid.
This prohibition has been the subject of a Special Advisory Bulletin published in 2002 by the Office of the Inspector General (OIG) for the Centers for Medicare and Medicaid Services (CMS) in 2002, was discussed in the OIG’s Supplemental Compliance Guidance for Hospitals in 2006, and has been the subject of at least two Advisory Opinion (in 2000 and 2007) published by the OIG. Since the definition of “remuneration” in the law is very broad, the prohibition has been applied to a wide range of items and services provided for free or less than fair market value by physicians and other providers to patients, including free transportation for patients, including free transportation for patients and/or family members, waiving co-payments, and gifts of more than “nominal” value (greater than $10 per gift, and $50 per year per patient).
For many physicians, the beneficiary inducement prohibitions seem counter-intuitive. Free or subsidized transportation is a good example. Many Medicare or Medicaid patients may be unable to obtain necessary medical care because they are unable to afford the cost of transportation to obtain that care. In many Wyoming towns and cities, public transportation is inadequate (either because it doesn’t exist or the patient is not healthy enough to use it) to get the patient to the most convenient source of needed health care. Providing free or subsidized transportation for the patient (something as simple as offering to pick the patient up at their home) would seem to many physicians simply the right thing to do to ensure that the patient gets the care they need. However, even providing local transportation to patients is only permitted under the beneficiary inducement rules under strict circumstances.
Likewise, the beneficiary inducement rules do not take into account the relationships between physicians, friends, family and acquaintances. A physician giving a $60 Christmas gift to a friend that is also a patient may be required to argue to the OIG that the gift was not given to induce the patient/friend to obtain services payable by Medicare or Medicaid from the physician.
However, in recognition of some of the more benign, and actually helpful, aspects of providing free or discounted goods or services to patients, Congress acted to loosen the beneficiary inducement rules in the recent Patient Protection and Affordable Care Act of 2010, as amended (the PPACA). In the PPACA, Congress specifically excluded from the definition of “remuneration”, “incentives given to individuals to promote the delivery of preventive care as determined by the Secretary in regulations so promulgated”. The scope of this exclusion has yet to be determined, since the Secretary of Health and Human Services has yet to finalize regulations interpreting this direction from Congress. Thus, it is hard to know how broad this exception will be. It could be interpreted to apply only to certain physicians, such as primary care physicians providing traditionally “preventive” services. However, Congress does appear to be shifting its enforcement focus away from activities that are meant to encourage the promotion of health and encouraging the OIG to do the same. How far that focus will shift will, however, be determined once the regulations themselves are created. The devil with the beneficiary inducements rules, as with many health care regulations, will remain in the details.
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