Calendar
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April 16, 2010
World Voice Day Celebration
4pm to 6pm
Voice and Swallowing Clinic
Harborview Medical
Center
More Info
FMI: (206) 744-3770
meyertk@uw.edu
April 22, 2010
2010 Spring Dinner Meeting
Seattle Tennis Club
"Challenging Cases
in Northwest Otolaryngology"
Registration Form
September 26-29, 2010
2010 AAO-HNSF Annual Meeting & OTO EXPO
Boston, MA
January 7-8, 2011
NWAO Winter Conference
Bell Harbor International Conference Center
Seattle, WA
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NWAO Board of Directors
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May Huang, MD
President
Craig Murakami, MD
Immediate Past President
Steven Bayles, MD
Secretary/Treasurer
Al Merati, MD
Program Chairman
Paul Abson, MD
Program Co-Chairman
Scott Manning, MD
AAO BOG Representative
Greg Davis, MD
Member-at-Large
Kris Moe, MD
Member-at-Large
Christine Puig, MD
Member-at-Large
Eric Waterman, MD
Member-at-Large
Shannon McDonald
Executive Director
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NWAO Website
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www.nwao.org
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Register Now: NWAO's Spring
Dinner Meeting
April 22, 2020
Seattle
Tennis Club
Challenging
Cases in Northwest Otolaryngology
Who should attend? Anyone with a challenging case. Who else should
attend? Anyone who may want to hire a new grad in the next few years, as we
expect a large resident turn-out.
Format:
5 minutes or
less case-based Power Point presentation. Pictures or video are required!
Please protect patient confidentiality with appropriate masking of photos. Entries due by April 20th. Please send them electronically to Greg Davis
MD MPH at gedavis@uw.edu.
Registration Form
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Physicians, Take Heed: New Health Care Reform Law Makes Significant Changes to Fraud and Abuse Laws
By Renee Howard,
Shareholder and Jill B. Scott, Associate
Bennett Bigelow & Leedom, P.S.
On
March 23, 2010, President Obama signed into law the Patient Protection and
Affordable Care Act (P.L. 111-148) ("Act"). Physician groups should pay
particular attention to provisions of this Act that affect the federal
physician self-referral ("Stark") law, the federal Anti-Kickback Statute, and
the False Claims Act. While some changes bring added clarity to these broad and
often inscrutable statutes, the clear theme of these amendments is heightened
government scrutiny of health care providers and enhanced prosecutorial tools
to fight suspected fraud and abuse.
Key Changes to
Stark Law
Disclosure
Requirements for Imaging Services. The
Act amends the Stark law's in-office ancillary services exception by adding a
new disclosure requirement. A group practice that makes a referral under this exception
for MRI, CT, or PET services is now required to inform the patient in writing
at the time of the referral that the patient may obtain the same service from
another supplier outside the group practice, and provide the patient with a
list of alternative suppliers in the area where the patient resides. The Act
gives the Secretary of Health and Human Services ("HHS") authority to expand
the disclosure requirement to include additional diagnostic services in the
future.
While
the effective date of this provision of the Act is January 1, 2010, the
disclosure requirement appears to have taken effect on March 23, 2010, the date
that the bill was signed into law. Although it is hoped that the Secretary will
delay enforcement of this provision while providers implement it, there remains
uncertainty as to the potential exposure of providers for failing to satisfy
this notice requirement in the interim.
Creation of
Stark Self-Disclosure Protocol.The
Act mandates the creation of a long-awaited formal self-disclosure protocol for
providers to self-report actual or potential violations of the Stark law, and
instructs the Secretary, in cooperation with the Department of Health and Human
Services Office of Inspector General ("HHS-OIG"), to develop and implement a protocol
within six months (late September 2010). Importantly, HHS-OIG will have
discretion to resolve Stark violations and reduce the amount due and owing for
violations based on the nature and extent of the improper practice, the
timeliness of the disclosure, and cooperation.
Strict
Limitations to Physician-Owned Hospitals.The Act significantly restricts the ability of physicians to
have ownership interests in hospitals under the whole hospital exception and
essentially prohibits such investments going forward. Existing physician
ownership of hospitals as of December 31, 2010 remains permitted, although the
law now prohibits physicians from increasing the total value of their
percentage of ownership interest beyond that held as of March 23, 2010. The
interplay between these dates creates inherent ambiguity over the parameters of
this grandfather clause.
Physician-owned
hospitals are also required to file an annual report with the Secretary, and
must meet certain requirements to qualify as bona fide physician investments
(e.g., ownership returns must be proportionate to the physician's ownership
interest). The Act also severely limits the physical expansion of
physician-owned hospitals (e.g., increasing the number of beds or procedure
rooms). The new restrictions also apply to any physician-owned hospital
qualifying under the rural provider exception.
Expansion of
Scope of Anti-Kickback Statute
The Act significantly expands the scope of the already broad federal
Anti-Kickback Statute, which makes it a crime to "knowingly and willfully"
offer, pay, solicit, or receive any remuneration to induce or reward the
referral of an item or service payable by any federal health care program,
including Medicare and Medicaid. In a move likely to cheer prosecutors,
Congress amended the act so that actual knowledge of the illegality of the
action and specific intent to violate the Anti-Kickback Statute are no longer
required to establish liability under that law.
The Act also provides that any claim submitted resulting from a referral made
in violation of the Anti-Kickback Statute automatically "constitutes a false or
fraudulent claim" under the False Claims Act. This, in conjunction with a
loosening of the intent requirement, may encourage the filing of more False
Claims Act cases premised on illegal kickbacks.
Elimination of False Claims
Act Defenses
The Act also makes specific changes to the False Claims Act, a law that
allows private citizens to file lawsuits on behalf of the government alleging
fraud against those who submit claims to the government, including medical
providers. The recent amendments to the False Claims Act will make it easier
for the government to prosecute such cases and for whistleblowers to initiate
such actions. Previously, the False Claims Act required dismissal of a
whistleblower's lawsuit if the allegations had been publicly disclosed in
certain forums. Now, the public disclosure bar to suit does not require
dismissal if the government opposes dismissal, giving the Department of Justice
an important role in determining a whistleblower's ability to proceed with an
action where the allegations have been publicly disclosed. Additionally, the
Act narrows the scope of what constitutes a "public disclosure," paving the way
for additional actions under the False Claims Act, particularly parasitic
lawsuits based upon publicly available information.
Obligation to
Quickly Return Overpayments
In order to encourage immediate reporting and return of
overpayments to federal health care programs, Congress created an obligation on
the part of providers to return overpayments and notify the relevant authority
of the overpayment by the later of: (i) 60 days after the date on which the
overpayment was "identified" or (ii) the date any corresponding cost report is
due. The retention of an overpayment after the relevant deadline triggers
application of the False Claims Act. The Act does not define the circumstances
under which overpayments are considered to have been "identified," and thus
providers are left adrift as to how they should balance the competing
considerations of fully investigating suspected overpayments and promptly
disclosing their existence. In light of these requirements, physician practices
should implement effective auditing and refund processing systems, and should
promptly investigate all suspected overpayments to ensure that all reporting
and refund obligations are considered and satisfied.
"Physician
Payment Sunshine" Provisions
Physicians with consulting or other arrangements with medical
device or pharmaceutical manufacturers should be aware that the Act requires
U.S. manufacturers of drugs, devices, and biological and medical supplies to
disclose "payment or other transfer of value" to physicians beginning March 31,
2013. Such manufacturers will be required to report the value, nature, purpose,
and recipient of the transfer of value. Although physicians do not have a
reporting requirement under this provision, they should be aware that
manufacturers will be tracking expenditures in 2012 order to be prepared to
report in 2013.
Home Health and
DME Certifications Require Face to Face Encounter
In an effort to crack down on perceived abuses in the ordering
of home health services and durable medical equipment, the Act requires
practitioners who order such services for Medicare and Medicaid beneficiaries
to conduct a face-to-face encounter (including through telehealth) with the
individual prior to issuing a certification for those services. Practitioners
must document the face-to-face encounter with the individual during the
six-month period preceding the certification, or other reasonable timeframe as
determined by the Secretary. The Secretary is authorized to apply the
face-to-face encounter requirement to other Medicare items and services based
upon a finding that doing so would reduce the risk of fraud, waste, and abuse.
Conclusion
The revisions to the fraud and abuse laws provided in the Act
impose substantial new requirements and expand the scope of liability in a
manner that that may demand extensive changes to physician group practice
operations and compliance policies. While many of the details pertaining to the
above-noted provisions will not be fully developed until after implementing
regulations are drafted, the new health care reform law provides ample
incentive for physicians and group practices to reaffirm their commitment and
dedication to compliance activities.
Author Bios and BB&L Contact Information
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Medicare SGR Disaster & Petition
The
Senate returns next week and is expected to promptly reconsider H.R. 4851, a
30-day measure that would extend the freeze on Medicare's physician payment
rates through April 30. By law, the 21.3 percent cut to Medicare physician
payments took effect April 1. However, the Centers for Medicare & Medicaid
Services instructed its contractors to hold claims containing services paid
under the Medicare physician fee schedule for the first 10 business days of
April. The WSMA has joined several medical societies across
the US in launching an online petition drive. The petition urges Congress to fix the flawed payment formula that
threatens care for Washington's 897,000 Medicare recipients, including senior
citizens and people with disabilities, and 337,000 military family members
covered by TriCare. Congress must
replace it with a stable, fair funding mechanism that reflects the true cost of
providing care. Please sign the petition today at:
http://www.ipetitions.com/petition/meltdown/. |
Captain Sullenberger- Boeing
Museum of Flight, 3/8/2010
Minutes from Scott Manning,
MD
Background-
Jan 15, 2009-Flight 1549 Airbus 280 - both engines flame out over Manhattan at
3200 feet elevation from bird strikes. 208 seconds later, Sully ditches in the
Hudson. This is the only example in the history of aviation of a plane that
large, ditching without breaking up.
Sullenberger is from Texas.
He started flying at age 17. He is a graduate of the US AF Academy and he was
an Air Force fight pilot flying among other things the F4 Phantom. He has been
a commercial pilot for 30 years and he has logged over 20,000 flying hours. He
is also a glider pilot and instructor.
He has a master's degree in industrial
psychology. He volunteered at the beginning of his career to be a pilot's union
representative for airline safety. He worked his way up to becoming an accident
investigator. He has been teaching safety and CRM (Crew Resource Management)
his whole career (he has been giving this same lecture his whole career - he
just got to embellish it with some interesting personal vignettes after
1/15,2009).
His mother was a career first grade teacher.
His father grew up in the depression and was a naval officer in WW II. He is a voracious reader and a lifelong student:
"A smart person learns from their mistakes. A wise person learns from the
mistakes of others (and from accidents)."
My observations of why he is a good speaker:
- He must be channeling his old Baptist minister.
He has great cadence - never gets rushed, pauses rhythmically with each
turn of his head to a new part of the audience.
- He looks vertically to the middle of the
audience; he turns his head horizontally to a new third of the audience
with each verbal pause.
- He is funny. (The Natl Trans Safety Board asked
if there was anything he would have done differently. "I would have chosen
to ditch in July"
- He is self-deprecating yet mildly edgy - like a
transition between the Great Depression generation and the anti-authority
'60s generation of his teen years. Even though his phrases when read seem
old fashioned and hackneyed, he pulls it off by his aura of quiet calm and
lack of ego.
He starts by acknowledging
his crew. Jeff Skiles the co-captain claims that he had the most important role:
flying into the geese so that Sully could become a hero.
Lecture
"This is a story of
preparation." "Experience the gift of passion for your work." "Follow your
passion. It's fun to be good at something difficult." His daughter asked "what
is the best job in the world?" He answered "something you would do even if you
did not have to." "What is integrity?" "It is doing what is necessary and right
even when not convenient." "What is the definition of a Captain?" "Always doing
what is right" (right on- Captain Kirk channeling!"
"I got here via hard work
starting at the Air Force Academy with its culture of excellence and
intolerance of failure. We have a moral duty to do this. I've always worked
hard to be prepared never knowing exactly when I would be challenged."
"Dedication and knowledge and
skill matter. Do not tolerate mediocrity. I have been trained to be intolerant
of any deviation (of SOP). Do not tolerate excuses or half measures. Be a
leader. With great authority comes great responsibility. You can not do everything yourself (CRM). The
leader is responsible for communicating the goals and establishing team
agreement regarding best practices to achieve the goals. I like to lead through
example. I call it 'realistic optimism.' The leader should demonstrate confidence
based upon preparation and practice."
He was asked on 60 minutes if
he had any doubts after the flame out. "No. I knew we could do it. We knew
which options were available. We instantly had a plan. Good organizations have a culture that
promotes quality. Employees must be
treated as partners and must interact with management. This leads to 'effective
action.' I met my co-pilot Jeff Skiles
just 3 days earlier yet we were able to communicate and act as an established team.
"The view that 'life is
unfair' is irrelevant in many ways. You can always make a part of your world
better. You choose to make positive differences. Be prepared. Demonstrate
realistic optimism. Our success in this case was the cumulative effect of
taking advantage of thousands of opportunities to be the best. On jan 14, 2009
I was a regular guy. On jan 15, the same guy yet changed forever. No one knows
what tomorrow will bring. Be prepared."
Questions and answers (many questions from pilots)
What was your airspeed?
"About 200 knots" . What is the ideal (engine re-light) speed for an Airbus
280? " About 300 knots." What about the ditch checklist? "It is 3 pages-
designed to go over at 35k elevation. We did not address it. It was not a
priority. I would have closed a few small vents. Our ditch resulted in
golf-cart size holes in the aft section so it was irrelevant."
What about the flame out
check? "Jeff Skiles managed to run through the re-light list for both engines
in less than the 208 seconds. We were very proud of that. Unfortunately, our
air speed was too low."
Why 'flaps two?' "We decided to pick a compromise between lift
and forward momentum." What was your ditch speed? "125.2 knots (143 mph)- 4
knots above minimum flying speed (!)."
Had you ever practiced
ditching? "There is a sim for high altitude preparation. None for this event as
there had been no previous example of loss of all thrust at low altitude over
water."
Did you ever think for a
moment that you might not make it? "No." This is what happened:
- Shock
- This can not be happening to me.
- I felt my perceptual field narrowing - so I
worked to calm myself
- I broke the situation down into a series of
problems that I knew I could solve:
fly the airplane (maintain airspeed and proper pitch), evaluate
landing options, pick the best option, decide on the best ditch
parameters, etc. We had no time. We had to focus only
on the highest priorities and ruthlessly ignore everything else.
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Governor
Creates Health Care Cabinet, Shuffles Some Positions, Applies for BHP Funding
At a Seattle
press conference April 1st the governor announced:
- Creation of a new Health Care Cabinet to coordinate the
state's implementation of the national health care reform bill.
- The following appointments:
- The new Health Care Authority Administrator - Medicaid
Director Doug Porter. Former HCA administrator Steve Hill moves over to
become Chair of the Puget Sound Health Alliance, and keeps his job as director
of retirement systems).
- The secretaries of DoH, and DSHS; and, the directors of the
Executive Policy Office and OFM.
- The Secretary of Corrections. The directors of
Retirement Systems, of Veterans Affairs, and Labor and Industries will be
involved on an as-needed basis.
- Jonathan Seib from her policy staff is now the "go-to-guy"
for reform and apparently will staff this group.
- Insurance Commissioner Mike Kreidler will be invited to
participate on issues within his jurisdiction. The OIC expects to have
about 2,000 insurance policies to review and approve as properly reflecting the
insurance reforms in the federal legislation and this needs to be done quickly.
- Application to keep BHP Afloat has
been submitted. The state might get $60 million for the rest of
this biennium to prop up the BHP, and more in the next biennium. The
governor indicated that the money would be sufficient to cover increased BHP
health care costs and another 5,000 BHP enrollees.
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DEA Publishes Regulation Permitting
E-Prescribing Of Controlled Substances
The
Drug Enforcement Administration (DEA) released an interim final rule (IFR)
outlining the process for practitioners to have the option of electronically
writing prescriptions for controlled substances. The IFR provides physician
practices, hospitals, and pharmacies with the ability to use modern technology
to issue these prescriptions while maintaining a closed system of controls over
the dispensing of controlled substances. Key provisions of the IFR include:
· The requirement that practitioners obtain authentication credentials from
federally approved credentialing service providers or certification
authorities. (Only DEA registrants may be granted the authority to sign
e-prescriptions for controlled substances.)
· A "two factor authentication" is required for the practitioner to prove his
or her identify (i.e., a password and either a hard token, such as a security
card, or use of a "biometric," such as retina or fingerprint)
· No paper duplicates of the prescription are allowed, unless the transmission
fails
· The security system used by the e-prescription software must, to the greatest
extent possible, prevent creation or alteration of a prescription for a
controlled substance by unauthorized employees of the practice
· Practice audit logs need to be modified to permit the development of a list
of auditable events (i.e., events that indicate a potential security problem)
· The e-prescription records must be reliable enough to be used in legal
actions.
Physicians practices' current e-prescribing software and workflows will most
likely need significant modification to comply the DEA's IFR requirements- especially in the
area of security. The IFR includes a 60-day comment period.
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CMS Issues Initial Announcements Related To The
Patient Protection And Affordable Care Act
The Centers for Medicare
& Medicaid Services (CMS) made the following announcement late last month
concerning implementation of provisions from the Patient Protection and
Affordable Care Act (PPACA):
1. Extension of Therapy Cap Exceptions Process - Outpatient therapy service
providers may continue to submit claims with the KX modifier, when an exception
is appropriate, for services furnished on or after Jan. 1, 2010, through Dec.
31, 2010. The therapy caps are determined on a calendar-year basis, so all
patients began a new cap year on Jan. 1. For physical therapy and speech
language pathology services combined, the limit on incurred expenses is $1,860.
For occupational therapy services, the limit is $1,860. Deductible and
coinsurance amounts applied to therapy services count toward the amount accrued
before a cap is reached.
2. Extension of the Outpatient Hold-Harmless Provision - Effective for dates of
service on and after Jan. 1, 2010, through Dec. 31, 2010, to rural hospitals
with 100 or fewer beds and to all sole community hospitals and Essential Access
Community Hospitals regardless of size.
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Benton Franklin Law
Suit: A Victory for Physicians
Last
month the Washington State Supreme Court issued a decision in Columbia Physical
Therapy, Inc. P.S. v. Benton Franklin Orthopedic Associates, P.L.L.C. et al,
clarifying the application of Washington's corporate practice of medicine
doctrine and Professional Service Corporation Act as well as Washington's
Anti-Rebate Statue to certain healthcare arrangements.
In a
case that was followed closely physicians associations throughout the country,
the ruling was very good news.
Background:
Columbia Physical Therapy, Inc, a service corporation owned by a group of
physical therapists, filed a lawsuit against Benton Franklin Orthopedic
Associates, a professional limited liability company owned by physicians and
employing physical therapists. The physician-owners of BFOA refer patients to
physical therapists employed by BFOA. Columbia Therapy asserted that the
arrangement violates the corporate practice of medicine doctrine and
Professional Service Corporation Act (PSCA), the Anti-Rebate Statue, and the
Consumer Protection Act. Had the plaintiff prevailed, physician employment of
several types of non-MD/DO caregivers would have been prohibited.
Read More
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CMS Releases
Guidance To Contractors On New Timeliness Standards For Processing Provider
Enrollment
The
Centers for Medicare & Medicaid Services (CMS) recently released instructions to contractors revising the timeliness standards for processing
Medicare paper 855 applications. Effective June 21, 2010, contractors must
process initial paper-based Medicare applications in a more expeditious manner;
Internet-based applications are not affected. If the application is complete
and no follow-up is necessary, contractors must process 80 percent of 855I and
855B applications within 60 calendar days of receipt and 95 percent within 90
calendar days of receipt. Time frames differ for applications requiring
follow-up. Providers should reply as soon as possible to any contractor
requests for additional or missing enrollment information, and applicants must
furnish the information within 30 days. CMS has emphasized the need for
Medicare providers to have accurate, up-to-date enrollment records in the PECOS
database. MGMA recently updated its Medicare Provider Enrollment Toolkit, which provides
guidance to members on the Medicare enrollment process.
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Tamper Resistant
Prescription Pads/Paper
A new
law signed by the governor in 2009 requires that prescriptions written in
Washington be on tamper resistant paper or pads (TRPP) approved by the
Washington State Board of Pharmacy. Beginning July 1 this year all medication
prescriptions hand delivered to a pharmacy must have a new look. While the
layout will be much the same as previous forms - with two signature lines for prescriber
and patient information - the forms will include a "seal of approval."
Prescribers, pharmacists, and patients can identify approved forms by the "seal
of approval" printed in the lower right-hand corner of the prescription form.
The
tamper resistant prescription paper and pads now in use won't comply with the
new law. Only board-approved forms are to be used for hard copy given to a
patient or patient designee, including prescriptions printed from an electronic
medical record system.
Read more
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ProviderOne Goes
Live May 9 - Are You Ready?
DSHS
has announced that the changeover to its ProviderOne system will take place May
9. All providers with Medicaid patients should have completed the three key
phases of this transitional process: Security, Registration and Claim Testing
Important:
1. If
your practice has not completed ProviderOne transition tasks (Security,
Registration and Testing), please contact the DSHS live help desk for
assistance at 1-800-562-3022. Option 2 (for provider) and Option 4 (for
ProviderOne). Or visit: http://hrsa.dshs.wa.gov/providerone/providers.htm
2. If
your practice has attempted to complete ProviderOne transition tasks (Security,
Registration and Testing) and has unresolved problems that require additional
assistance beyond what the help desk has provided, please post the specifics of
the issue (including your Provider ID# and/or Help Desk ticket #), so we can
share those comments with DSHS lead staff.
View Announcement
View Key Dates for Cutover and Transition
If
you have additional questions of ProviderOne contact Gena Cruciani by email to CRUCIGM@dshs.wa.gov
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Medicaid to Start Mailing Out Plastic ID cards
During
April, the Department of Social and Health Services will start mailing its one
million medical assistance clients the same kind of plastic ID card used by
private health insurance companies.
The
new "Service Cards" are part of the changeover to the new ProviderOne payment
system, which will go on line May 9. They represent a convenience for clients,
doctors, dentists, hospitals and other kinds of providers. They replace monthly
mailings of a paper coupon.
The
new cards, which are free, will be mailed out first in the Spokane area and
northeastern Washington, from April 9 to April 13.
The
rest of the mailings will cross the state, finishing in the southwestern corner
of the state:
·
April 14-19: Other Eastern Washington points
· April 20-23: Northwestern Washington
· April 24-28: King County
· April 29-May 3: Pierce County
· May 4-7: Olympic Peninsula and Southwestern Washington
Read More
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Membership Directory
This online membership directory is password protected and
only your fellow colleagues will have access to your practice information.
Please visit http://www.nwao.organd clink on
the directory tab to view the membership directory.
Member Directory
Access Information:
Member Directory Login: nwao
Password: ents
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Membership Report
If you haven't paid your 2009 Membership
Dues, please do so right away. Your
practice information will be deleted from the membership directory if not paid.
98- Active Members
92- Delinquent Members
69- Non-Members
6 - Retired Members
Encourage your colleagues to join the NWAO and help build a strong organization
to support your specialty. For
membership questions, email the NWAO at smc@wsma.org.
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About Us
Northwest Academy of Otolaryngology
Executive Director - Shannon McDonald
2033 6th Ave, Suite 1100 | Seattle, WA 98121
Phone: 800.552.0612 | Fax: 206.441.5863
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