NWAO

Friday June 17, 2011

Mark your Calendars for upcoming NWAO Events

Spring Dinner Meeting
Friday, October 14, 2011
Seattle Tennis Club

NWAO Winter Conference
January 6-7, 2012
Bell Harbor International Conference Center

Complete list of Otolaryngology Educational Events

AMA PRA Enduring Material Minimum Performance Level Takes Effect July 1

The AMA Physician Recognition Award (PRA) credit system has changed how physicians receive CME credit for enduring materials. A minimum passing score must be obtained in order to receive AMA PRA Category 1 Credit™. The Academy has established a minimum passing score of 70% for all of its enduring materials, including AcademyU®, Home Study Course, and Patient of the Month Program. Physicians will have a retest option to reach a passing score. Send an email to ce@entnet.org for more information.

Governor Signs Legislation Clarifying Scope of Ambulatory Surgical Facility Licensure La

On April 14, 2011, Governor Christine Gregoire signed into law Substitute House Bill 1575, legislation that clarifies the scope of Washington’s ambulatory surgical facility licensure law (the “ASF Licensure Law”).

The ASF Licensure Law was effective July 1, 2009. However, significant confusion regarding its implementation by the Washington State Department of Health (DOH) led to the introduction of legislation by Representative Eileen Cody on January 26, 2011 designed to eliminate that confusion and to clarify the types of facilities that are subject to the ASF Licensure Law.

Background

Codified at chapter 70.230 RCW, the ASF Licensure Law requires any distinct entity that operates for the primary purpose of providing specialty or multispecialty outpatient surgical services in which patients are admitted to and discharged from the facility within 24 hours to be licensed by DOH as an ambulatory surgical facility. The law excludes from its scope “outpatient specialty or multi-specialty surgical services routinely and customarily performed in the office of a practitioner in an individual or group practice that do not require general anesthesia.” This provision in the law is often referred to as the “practitioner office exception.”

On October 20, 2009, DOH issued guidance in the form of “Frequently Asked Questions” in which it changed its interpretation of the ASF Licensure Law. Specifically, DOH narrowed the applicability of the law by broadening the practitioner office exception. According to its guidance, DOH interpreted the ASF Licensure Law to apply to only those facilities where outpatient surgery is performed with general anesthesia. Consequently, practitioner offices as well as ambulatory surgery centers where outpatient surgery is performed without general anesthesia became ineligible for licensure. As a result of the change in DOH’s interpretation of the ASF Licensure Law, approximately 60 ambulatory surgery centers that were licensed in July 2009 were required to relinquish their licenses to DOH.

Substitute House Bill 1575

In response to DOH’s change in its interpretation of the ASF Licensure Law, SHB 1575 was introduced on January 26, 2011. It is anticipated that the enactment of this legislation will permit these ambulatory surgery centers to regain their licenses.

Under SHB 1575, “ambulatory surgical facility” is defined to include surgical suites that are adjacent to the office of a practitioner if the primary purpose of those suites is to offer specialty or multispecialty outpatient surgical services, regardless of the type of anesthesia used. Such surgical suites may share certain spaces with the office of a practitioner, including a reception area, restroom, waiting room, and walls.

In addition, SHB 1575 clarifies the scope of the practitioner office exception. Under SHB 1575, that exception applies to outpatient specialty or multispecialty surgical services routinely and customarily performed in the office of a practitioner in an individual or group practice, where the primary purpose of the office is not the performance of surgical services. Where general anesthesia is a planned event, surgical services must be performed only in a licensed ambulatory surgical facility or in a licensed hospital or hospital-associated surgical center.

It is important for practitioner offices and ambulatory surgery centers to assess whether, under SHB 1575, their facilities are required to be licensed by DOH as ambulatory surgical facilities and, if not, whether physicians performing surgery in their facilities are subject to other regulations, such as the Medical Quality Assurance Commission’s newly adopted office-based surgery rule.

This article has been prepared by Emily R. Studebaker of Garvey Schubert Barer. For more information, please contact Ms. Studebaker at (206) 816-1417, estudebaker@gsblaw.com. This article is not a substitute for legal advice. Transmission and receipt of this publication does not create an attorney-client relationship.

Nominations Open for the 2011 Helen F. Krause, MD Trailblazer Award

The AAO-HNS Women in Otolaryngology (WIO) section is accepting nominations for the Helen F. Krause, MD Trailblazer award. This annual award recognizes and individual who through scholarship, advocacy, leadership, and/or mentorship has furthered the interests of women in the field of otolaryngology. Click here to complete the application. The deadline is August 15, 2011.

Washington Legislative Session Report

Thousands of bills, hundreds of health care issues, scores of impasses and late night negotiations later, the state legislative session has come to a close. Thanks go to all the physicians and practice managers who heeded our requests to contact their legislators during the regular and special sessions. Their efforts made a difference. Below is a brief end of session recap on some of the issues WSMA addressed. Greater detail is available at www.wsma.org (Government Relations, Legislative Agenda).

The final budget reduced state spending by $4.6 billion (more than 12 percent of the overall budget). The total operating budget is $32.2 billion. A reserve of $723 million has been left. No new taxes were raised, but a number of fees were increased or added in various sectors. There were, however, no fee or tax increases for the medical community, in spite of a number of proposals to do so.

The BHP: New enrollment will be frozen, with about 37,000 persons per month expected to be covered during FY 2012, and an average of 33,000 per month during FY 2013. (There are currently approximately 42,000 covered.)
Interpreter services: By January 2012, the medical assistance program will develop a new system for delivery of spoken-language interpreter services—developing guidelines for the appropriate use of telephonic, video-remote and in-person interpreting. Medical practitioners will use a secure web-based tool to schedule appointments for interpreter services, one that identifies the most appropriate and cost-effective method of service delivery.
There are no directed payment cuts for physicians.
Emergency room visits in the Medicaid program will be limited to three non-emergent visits per year. The WSMA and the state hospital association are specified in the budget to be included in developing the criteria for defining non-emergent.
Hospital inpatient and outpatient rates for Prospective Payment System hospitals are reduced by 8% and 7%, respectively. These reductions will not apply to payments for psychiatric inpatient services. Revenue to the Hospital Safety Net Assessment Fund is forecasted to exceed projected expenditures and the excess is to fund hospital services that would otherwise be funded from the state general fund.
Federally-qualified rural health clinics (RHCs) will be paid their standard cost-related encounter rate for prenatal and well-child services provided to women and children enrolled in the Medicaid and State Children’s Health Insurance programs. Additionally, such visits will be considered eligible for the standard encounter rate for purposes of reconciling managed care enhancement payments for 2009 and 2010.
Medicaid will reduce cesarean section births via promoting evidence-based practices through outreach, metrics and feedback reports.
There will be prior authorizations for state programs for advanced imaging and surgical procedures for orthopedic procedures, spinal procedures and interventions, and nerve procedures.
The Children’s Health Program was partially preserved, but premiums will now equal the average state-only per capita cost of the coverage for children with family incomes at or below 200 percent of the FPL.

Currently there are separate limits for physical, occupational, or speech therapy. These services will be combined into one rehabilitation benefit and the number of visits or units available will be limited for adults. Patients with spinal, knee, hip or traumatic brain injuries will receive up to 12 non-physician visits per year. All other patients will receive a maximum of 6 visits per year.

Value-Based Payment Rules May Be Bound for ASCs

Ambulatory Surgery Centers that perform cataract, endoscopy, colonoscopy, and laser eye surgery could soon be paid on the basis of quality measures under a plan unveiled by the U.S. Department of Health and Human Services.

Full Article

Statewide Credentialing Service—Participate Now!

ProviderSource is an easy-to-use online portal to the OneHealthPort Provider Data Service, a statewide system for centralized collection, verification and distribution of all provider data to be used for credentialing and privileging. Physicians’ practices should become familiar with the use of that system as Washington health plans begin to use that electronic resource. Each credentialed provider or practitioner must be set up with his or her own unique OneHealthPort login. Be sure to go through the online guidance to help your practice get started, posted at www.onehealthport.com/services/providersource_live.php.

For questions, contact Teresa Davis RN at OneHealthPort, 206.624.3128 ext. 152, or email tdavis@onehealthport.com.

Negotiating the Health Information Technology Briar Patch

The promise of HIT is lavishly documented. It is eclipsed only by the challenge of sorting out your options amidst all the complexities. Here are some resources that will help.

WSMA – The Practice Resource Center on the WSMA’s website has the most relevant materials and web links at their Health Information Technology - Stimulus Incentive Funds section.

WIREC Group Purchase – A new development is the vendor selection for the Group Purchase Program through WIREC, the Washington & Idaho Regional Extension Center, a federally supported initiative conducted by Qualis Health. WIREC has chosen seven electronic health record (EHR) vendors that have agreed to offer discounted rates and enhanced service level agreements to WIREC-enrolled providers.

The selected vendors - Allscripts, eClinicalWorks, eMDs, GE, Greenway, NextGen and Pulse - were identified by WIREC’s Group Purchase Stakeholder Committee as offering strong features, solid service level agreements and competitive pricing to primary care providers. WIREC Group Purchase Program benefits are available only to WIREC enrolled providers. Enrollment in WIREC is still open to eligible Washington and Idaho primary care providers. For more information go to www.wirecqh.org.

AMA AMAGINE – The AMA has launched the AMAGINE™ Physician Portal, a secure, internet-based tool that integrates a wide range of technologies within a single access point. The AMAGINE portal enables physician practices to access patient history from many sources, manage all aspects of treatment, improve patient safety, tighten billing cycles, and more.

It features over 20 HIT solutions and resources for a wide range of common practice management challenges, including EMRs, ePrescribing, patient registries, clinical decision support tools, revenue cycle management, patient education, lab ordering, and full-text access to AMA journals. AMAGINE also provides a virtual health record where physicians can share and access data through a single, secure sign-on with access to multiple applications.

CMS Offers Proposed Modification of E-Prescribing Penalty Policy; Beware the Deadlines

CMS has issued a proposed rule that makes significant changes to the e-prescribing penalty program by adding more exemption categories so that physicians are not unfairly penalized for failing to meet the requirements under the 2012 e-prescribing penalty program.

Physicians are still required to e-prescribe using a qualifying e-prescribing system and report the G8553 code on at least 10 Medicare Part B claims from January 1, 2011 through June 30, 2011 to avoid the 2012 e-prescribing penalty. In order to avoid the 2012 e-prescribing penalty, physicians will have an opportunity to attest through an online web portal that they should be eligible for one of the following exemptions:

Physician is registered to participate in the Medicare or Medicaid EHR Incentive Program and has adopted certified EHR technology
Physician’s practice is located in a rural area without high speed internet access
Physician’s practice is located in an area without sufficient available pharmacies for electronic prescribing
Physician is unable to electronically prescribe due to local, state, or federal law or regulation (e.g., prescribes controlled substances)
Physician infrequently prescribes (e.g., prescribe fewer than 10 prescriptions between January 1, 2011–June 30, 2011)
There are insufficient opportunities to report the e-prescribing measure due to program limitations

Physicians will have to apply for an exemption from the 2012 e-prescribing penalty via the web-portal tool by October 1, 2011. The link to the e-prescribing proposed rule is posted on the “Statute Regulation” section of the E-Prescribing Incentive Program website.

The proposed rule will be published in the Federal Register on June 1, 2011. The comment period will close on July 25, 2011. The AMA will be reviewing the proposed rule in more detail.

Resources to Get You Ready for ICD-10

CMS has created some fact sheets to prepare you for the ICD-10 transition on October 1, 2013. You can view the resources here:

LNI PROVIDER FEE SCHEDULE: The 2011 Medical Aid Rules and Fee Schedules (MARFS) is now available

The department has published the 2011 edition of the Medical Aid Rules and Fee Schedules. LNI Fee Schedules

Congress Delegation Returns from Recess to the Day-to-Day Grind of Washington DC

While the debt ceiling countdown looms ever closer, the routine work of Congress trundles on as we work our issues of import. Over the past few weeks, the WSMA has been in contact with members of the delegation on such things as:

The draft ACO regulations – Senator Cantwell’s office is in contact with other senators about a “dear colleague” letter urging CMS to revise some of the more egregious shortcomings in its draft rules.
The Independent Physicians Advisory Board (IPAB) – Republicans have signed on to repeal that provision of the federal reform act; the Senate won’t.
A House bill on pain medication rules - our advice to the member who is considering co-sponsoring the legislation: it is a real problem; just don’t make matters worse than the solutions this state’s MQAC is trying to impose here.
Analysis and comment on the recently released IOM report on Medicare Payment Geographic Payment Issues - rather esoteric, preliminary - this is the first of three reports with the last one due out in Spring of 2012, and including nothing that would penalize this state and some things that might actually benefit us.