Practicing Physicians Advisory Council (PPAC) UpdateDate: Saturday October 19, 2002 I promised to keep you informed on the PPAC (Practicing Physicians Advisory Council) meetings and actions. As you recall, the PPAC is a group of 15 physicians from across the country who act as an advisory council to the Centers for Medicare and Medicaid Services. Medicare Payment Cuts The most recent meeting had as a major focus the Medicare payment cuts. Previously we had requested that CMS support legislation that would immediately halt the 5.4% Medicare fee decrease and repeal the sustainable growth rate system to replace it with a system that reflected the increases in practice costs and changes in technology. At this meeting, we made more specific recommendations. We recommended that CMS do everything administratively possible, including but not limited to:
We also requested that CMS stop assuming a yearly 30% increase in physician productivity since physicians have maximally increased their productivity. There really is no acceptable measurement for physician productivity. We suggested that, if any changes in the Medicare reimbursement rates occur, the time for physicians to sign up for Medicare be extended past the 12/31/02 date so that physicians might decide to continue Medicare participation. Our concern was that with the current decrease in Medicare reimbursement, many of our seniors will have diminished access to care, because physicians will look at the fee cuts and not elect to sign up. If we can get some of the changes enacted legislatively or administratively that improve physician fee schedules, more physicians may be willing to sign up to be participating physicians in Medicare for 2003. Medicaid Medicaid was also discussed at length. PPAC requested that HHS Secretary Tommy Thompson establish a National Medicaid Payment Advisory Commission to address the physician payment issues in the Medicaid program and the effect on access and participation. We requested that CMS work with the states to measure access and participation rates and to the extent possible to encourage equal access to Medicaid across the states. We recognize that Medicaid is a state run program but CMS spends a tremendous amount of money financing the Medicaid program and there are gross inequities from state to state. Carrier Medical Directors Several of the Medicare carriers have elected to eliminate or consolidate the Carrier Medical Director programs. We felt that this was an important part of the educational process which informs physicians how to comply with Medicare. We applaud CMS's goal of education rather than fraud and abuse investigations, but felt that the decrease in Medicare carrier medical directors was working in cross purposes to this goal. We therefore requested that Medicare require their carriers to provide an adequate number of carrier medical directors with adequate financial support to fulfill CMS's goals for physician education and to adequately continue timely claims adjustment, to maintain adequate knowledge of the provider community and provide accurate and timely answers to provider and beneficiary questions. Medical Review Policies We also discussed the issue of nationwide medical direction policies as opposed to local medical review policies, as described in BIPA 522. This is a new program in response to legislation which allows patients to challenge local medical review policy decisions and obtain coverage. After an excellent discussion by CMS of this policy, it was felt that very few patients would actually invoke this process and that because no funding was allowed for the administrative law judges who might reverse these decisions, that some changes needed to be made. We felt that the carriers should not be allowed to hold up the administrative process while they reviewed new data as the administrative process already takes several years. A several year review process would make it impossible for most patients to participate in this policy. We then suggested that CMS explore the possibility of a prior authorization process. It would be far more useful to both beneficiaries and physicians if we knew in advance what procedures would be paid for and which would not. Self-Administered Drug Policy Another topic of great interest was the self-administered drug policy. PPAC felt that it was not fair to have Medicare beneficiaries who would never be able to self-administer drugs deleted from the denominator of Medicare patients who might self-administer drugs. We felt that all Medicare patients should be considered in that pool as the policy for not paying for drugs felt to be usually self-administered would work against these more unfortunate Medicare beneficiaries. We therefore requested that Medicare enact a policy that if 50% of all Medicare beneficiaries generally can self-administer a drug, it should be considered self-administered and therefore not covered, but then the local carrier medical directors be allowed some latitude for individual patient-by-patient determinations. We felt that this would best take the individual abilities of a patient to administer a drug into account. Preventive Care / GPCI We also discussed the potential future trends in Medicare payment for preventative health care and concluded the meeting with a discussion of the geographic practice cost index (GPCI). PPAC suggested that Medicare evaluate whether or not using business rents across the various communities might result in a more equitable reimbursement plan than using apartment rents, and suggested that liability insurance rates should be updated to reflect the current medical liability insurance climate. Feedback Once again, if you have input into positions we have taken or suggestions for other agenda items, please send me feedback. Thank you for taking the time in reading this. Sincerely, Barbara L. McAneny, M.D., F.A.C.P.
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