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

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Regulatory relief must also focus on Medicare contractors

The College has been working with a number of other medical organizations to advocate for legislation that would change the way Medicare contractors work with physicians.

In an Aug. 30 letter to key legislators in both the House and Senate, ACP-ASIM and nearly 100 other organizations voiced support for the Medicare Education and Regulatory Fairness Act of 2001 (MERFA). The groups pointed out, however, that the legislation does not address the need for contractor reform.

In part, the letter said that physicians and providers need a single point of contact in each state to serve as a liaison between providers and individual contractors. It also noted that physicians should not have to deal with bureaucracies in which contractors blame each other for problems.

The letter emphasized that local carrier advisory committees should be continued to be used in each state to make sure that local policies reflect the consensus of area physicians. These advisory committees should be charged with reviewing changes in local coverage decisions.

The text of the Aug. 30 letter is available online at www.acponline.org/hpp/contract_reform.htm.

In a July 30 letter to legislators, the College and 51 other medical organizations called on Congress to standardize and streamline the process by which Medicare contractors investigate alleged overpayments.

In part, the letter said that Medicare needs to ensure that physicians and providers receive due process rights during appeals, that contractors provide reliable answers to physicians' questions; that evaluation and management (E/M) documentation guidelines accurately reflect physicians' work; and that Medicare establish a repayment mechanism that doesn't punish individuals who voluntarily come forward to report overpayments.

The text of the July 30 letter is available online at www.acponline.org/hpp/merfa_prin.htm

Proposal to broaden access should be expanded

While the College supports a new proposal to broaden access to care for the nation's poor and underserved, it says that more changes are needed.

In an Aug. 20 letter to HHS Secretary Tommy Thompson from ACP-ASIM President William J. Hall, FACP, the College said it supports the Health Insurance Flexibility and Affordability (HIFA) Initiative, which aims to cut the ranks of the uninsured. In the letter, however, ACP-ASIM suggested the following changes to Medicaid and the State Children's Health Insurance Program to expand health care coverage:

  • Replace current eligibility standards with a federally mandated income standard and increase the federal contribution to both programs.
  • Establish a minimum level of benefits.
  • Increase outreach efforts and simplify the application process.
  • Increase reimbursement to physicians to cover their costs of providing services.
  • Simplify the Section 1115 waiver renewal process to provide predictable and sufficient funding.

The letter is available online at www.acponline.org/hpp/hifa.htm.

CMS should not change reimbursement for post-critical care

The College is protesting changes that would eliminate payment for multidisciplinary services provided to chronically ill patients who undergo surgery.

In an Aug. 6 letter, ACP-ASIM joined 35 medical organizations in urging the Centers for Medicare and Medicaid Services (CMS), formerly HCFA, to abandon changes it is considering in Medicare payment policies for postoperative critical care.

In June, the agency proposed changing its reimbursement policies for postoperative patient care, apparently because it fears Medicare will be paying for the same services more than once when another payment policy for critical care services takes effect Jan. 1, 2002. Beginning then, Medicare will include payment for critical care services in the global surgical fee for approximately 130 procedures

.

The letter asked CMS to acknowledge that postoperative services provided by operating surgeons to patients in the intensive care unit do not duplicate the services provided by other physicians on the same day. "As patients with more co-morbidities undergo procedures," the letter stated, "the quality of the outcomes depends increasingly on care by teams of physicians."

The letter also pointed out that medical literature confirms the value of multidisciplinary care for critically ill postoperative patients.

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