Practicing Physicians Advisory Council (PPAC) UpdateDate: Friday August 16, 2002I would like to share with you information which I receive as a member of PPAC and to receive your input on issues to be discussed. The Practicing Physicians Advisory Council is an organization made up of 15 physicians from across the country set up by law to advise the Secretary of Health and Human Services and the Centers for Medicare and Medicaid Services on the physicians' perspective on issues regarding Medicare and Medicaid. The council meets quarterly. I realize you are busy but, I feel that PPAC will be more useful if concerns of the medical community and AMA leadership can be directed to it. I would be glad to receive your comments and concerns, and present them at PPAC meetings. Physician Participation in Medicare At the June meeting, the CMS survey of Medicare beneficiaries access to physicians was discussed. The survey data from CMS in general did not show a problem with Medicare access. However, this did not fit with the personal experience of several PPAC members. We suggested that assessing access to specific specialties of concern to Medicare patients might be an effective early warning system to predict general access problems. We suggested that CMS assess delay in weeks for appointment availability, and survey for limitations placed by physicians on the percentage of Medicare patients they would allow in the practice. Partnering with the AMA and medical specialty societies and other physician groups was also suggested. EMTALA EMTALA was discussed at length and PPAC recommended specific language stating that "Physicians are not required to restrict their activity while on call solely to cover their on call responsibility". EMTALA does not prohibit, for example, doctors being in the operating room while on call, being on call simultaneously at more than one hospital, or attending to other responsibilities of their practice while on call. The council also recommended specific language suggesting that EMTALA does not apply to patients coming to the emergency department to obtain previously scheduled or follow-up care. The council felt that many patients are scheduled to come in for things such as suture removal and that should not constitute an emergency medical condition under EMTALA. The council recommended that a cooperative project be developed to address reimbursement mechanisms for EMTALA related services when patients don't have insurance. We also recommended that PRO review be mandatory early in the process of the enforcement procedures as well as a mechanism be developed to insulate peer review from discoverability in the context of EMTALA investigations. A discussion on multiple casualty incidents and the necessity to triage patients requiring less than full emergency department resources to another facility without incurring EMTALA violations was discussed. This will be discussed further at the next meeting. HIPAA A brief discussion of HIPAA occurred at the June meeting. A far more extensive discussion occurred at the March meeting in which we recommended that the proposed HIPAA privacy rules protect minors and their medical records seeking services related to domestic violence, contraception and sexually transmitted disease. At the March meeting the recommendation was made that the cost of HIPAA should be taken into account for yearly physician fee updates and that the HIPAA privacy regulations eliminate the business associate provisions that regular contracts between physician practices and their business associates. This was in order to limit physician liability for actions beyond their control done by business associates. It was also recommended that the privacy regulations be written as narrowly as possible so that physician liability would be limited in terms of giving notice to patients and obtaining approved consents. Medicare Reimbursement Cuts In the March meeting a letter was sent to Secretary Thompson requesting that CMS support legislation to halt the 5.4% Medicare payments cuts and repeal the Sustainable Growth Rate System, replacing that system with a new formula which appropriately reflects practice costs. We also adopted the AMA's recommendations to have the Department of Health and Human Services and CMS use its administrative authority to change the productivity measure instead of waiting for a directive from Congress, as well as adjusting the payments to reflect changes in liability, outpatient drugs, the previous errors in the sustainable growth rate, and to abandon the assumption that volume would increase if the sustainable growth rate was repealed. At the June meeting, this was again discussed and the council also recommended that CMS staff evaluate what the change would be if the geographic practice cost index was calculated in a different manner in order to make the index more specific to medical practice. Feedback I hope this update is helpful and will stimulate thought and comments from AMA membership. Please send your comments and I will be glad to use your input at further PPAC meetings. Thank you for taking the time in reading this. Sincerely, Barbara L. McAneny, M.D., F.A.C.P.
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