American College of Physicians: Internal Medicine — Doctors for Adults ®

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Editor's note: In this issue, ACP-ASIM Observer introduces a new section in College Watch that focuses on the activities and positions of the College's Washington office.

Policy Briefs

From the July/August 1998 ACP-ASIM Observer, copyright 1998 by the American College of Physicians-American Society of Internal Medicine.

ACP-ASIM restructures public policy activities

As part of the merger with the American Society of Internal Medicine (ASIM), the College has restructured its Health and Public Policy Division to better address important issues facing physicians.

While the Health and Public Policy Committee will continue to focus on broad issues, a new Medical Services Committee will focus on issues such as third-party payment, coding and documentation, and the work of government agencies such as HCFA. Cecil Wilson, FACP, a new ACP-ASIM Regent and a former ASIM trustee, will head the committee.

Two subcommittees have also been formed. The new Third-Party Relations, Coding and Payment Subcommittee is charged with making recommendations to the Medical Services Committee on issues such as coding changes.

The new Managed Care Subcommittee, which will report to both the Health and Public Policy Committee and the Medical Services Committee, is responsible for trying to improve policies adopted by managed care organizations and making sure they protect the rights of patients enrolled in managed care plans. It is also responsible for providing advice to the Board of Regents on ways to help internists practice high-quality, cost-effective care in a managed care environment. The subcommittee will be composed of practitioners, executives of major health care organizations, an ACP-ASIM Governor and a medical director of a physician-owned or physician-run health plan.

AMA delegates: Revise E/M guidelines

At its June meeting, the AMA's House of Delegates told its CPT editorial panel to come up with "simplified" evaluation and management (E/M) guidelines that do not require physicians to use complex formulas in documenting patient care.

The House of Delegates said that the CPT panel should work with HCFA to "develop simplified E/M guidelines that are clinically relevant, realistic and practical and do not require either excessive physician time or documentation in excess of that necessary for good patient care." The delegates also said that they opposed any documentation system that would require doctors to use "quantitative formulas" or any documentation system that would assign numeric values to elements in the medical record.

By opposing any numerical criteria, the delegates directed AMA to re-examine newly revised E/M guidelines released in mid-June for comment. Those guidelines, which would have required physicians to document a certain number of key elements of services in order to meet documentation requirements, were opposed by many medical organizations, including ACP and ASIM.

The new ACP-ASIM Subcommittee on Third-Party Relations, Payment and Coding will meet July 14 to consider what next steps the College should take to make sure the E/M guidelines are revised fairly.

In other news from the House of Delegates meeting, ACP introduced two resolutions and ASIM introduced one resolution.

  • One resolution proposed by ACP requested that the AMA endorse the Consumer Bill and Rights and Responsibilities developed by President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. This resolution was referred to AMA's Board of Trustees for further study.
  • The other ACP resolution asked that that the AMA work to modify the primary care exception rule to allow on-site teaching physicians in primary care clinics and in physician offices to bill for some evaluation and management services they provide directly, as well as for those provided by residents. This resolution was also referred for further study.
  • ASIM's resolution asked that the AMA oppose any directive from HCFA to slow down payment of Medicare claims or reduce needed carrier services to physicians and patients; oppose so-called user fees or other de facto taxes on physicians who provide services to Medicare patients; and urge Congress to appropriate sufficient funds to support an adequate level of service by HCFA and its carriers to physicians and patients, as an alternative to reductions in carrier services or so-called user fees. This resolution was combined with other motions into a new substitute resolution opposing user fees and adopted.

ACP-ASIM Regent elected to AMA council

ACP-ASIM Treasurer and Regent James L. Borland Jr., FACP, last month was elected to a four-year term on the AMA's Council on Medical Education. The council studies and issues recommendations on topics related to medical education and training-from undergraduate to continuing education—that come before the AMA.

Dr. Borland, a retired gastroenterologist from Jacksonville, Fla., and life-long university and community-based teacher and practitioner, was among four candidates who sought the one non-incumbent slot on the council. He campaigned on a platform to expand community-based teaching, address physician-supply problems, and improve education in areas such as end-of-life care, family violence and nutrition.

Regulatory relief for physician labs

Earlier this spring, HCFA made several changes to ease the excessive burden of the 1992 Clinical Laboratory Improvement Amendments (CLIA). Both ASIM and ACP had long advocated for changes to the regulations affecting physician offices. The following changes apply to all labs covered by CLIA:

  • Labs can now undertake education and/or training to correct unsuccessful performance after going through their first round of proficiency testing;
  • HCFA will require less frequent onsite inspections and instead rely on self-inspection for labs with superior track records (frequency of inspections will depend on each lab's history); and
  • HCFA will announce in advance all initial and recertification inspections. Follow-up inspections—and those prompted by patient complaints—will continue to be unannounced.

"Same day" screening tests

HCFA has retracted one of the "same-day" billing restrictions it enacted in last April.

HCFA withdrew the restriction against billing for fecal occult screening tests (G0107) performed on the same day as an evaluation and management (E/M) service is billed for the same patient. While the agency is also considering lifting similar same-day payment restrictions on other services, it has not provided any details on how physicians should submit-or resubmit-same-day claims that are now allowed.

HCFA stopped paying physicians in April for the new pelvic/breast (G0101) and colorectal screening services (G0104, G0105, G0107 and G0120) when performed on the same day as an E/M service for the same patient. ASIM had argued against the payment restrictions.

According to officials from ACP-ASIM's Washington office, internists who are preparing Medicare claims for any of above "G" codes in conjunction with an E/M service should not submit them until HCFA announces new billing instructions.

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