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Policy briefs

From the December ACP Observer, copyright 2003 by the American College of Physicians.

  • Changes in Medicare pay for drugs should exempt vaccines
  • College calls on Calif. insurer to stop recoding E/M services
  • New study: Most internists treat uninsured patients

Changes in Medicare pay for drugs should exempt vaccines

Any changes in Medicare's payment policies for drugs should exempt vaccines to avoid decreasing immunization rates among the elderly.

That was the message from the National Influenza Summit, a group that includes ACP and 26 other organizations, to Thomas A. Scully, Administrator for the Centers for Medicare and Medicaid Services (CMS).

In an Oct. 14 letter to Mr. Scully, the coalition urged the CMS to consider any payment reforms for vaccines separately from other drugs. Any changes in vaccination rates, the group said, should aim to increase immunization rates among seniors by making sure that payment rates don't create financial barriers for practices that administer adult vaccines.

The coalition letter pointed out that the number of senior citizens who have died from influenza has increased in recent years. The letter also explained that the vaccine supply—and the vaccination rate—is vulnerable to changes in payment policy.

The coalition letter is online.

College calls on Calif. insurer to stop recoding E/M services

ACP is calling on a California insurer to stop recoding physician services using a methodology that appears to be aimed at reducing physician reimbursement.

In May, Health Net of California issued a provider update announcing a new "recoding policy" that would affect claims for evaluation and management (E/M) services. The update explained that the health plan would use a series of tables it developed to recode E/M services.

In an Oct. 20 letter to the health plan, the College said that using payment tables to "supplant" definitions contained in both Medicare's E/M documentation guidelines and Current Procedural Coding is "indefensible" without a detailed explanation of how the tables were created. The health plan has not clarified how it assigns diagnosis codes to levels of service, nor explained whether physicians were involved in the formation of the policy.

ACP questioned whether Health Net was using the recoding system to merely downcode claims. The letter pointed out that paying an E/M service at a different rate than what physicians have billed is inappropriate, and that it also forces physicians to submit medical records to receive payment for the level of service they originally billed.

ACP's letter is online.

New study: Most internists treat uninsured patients

Nearly 70% of general internists provide charity care, typically to existing patients who have lost insurance, according to the November-December issue of Health Affairs.

New York Academy of Medicine researchers worked with the ACP Foundation and the Commonwealth Foundation to survey ACP members.

In a press release, ACP President Munsey S. Wheby, FACP, pointed out that private physicians provide five times as many visits for the uninsured as safety net hospitals and other institutions.

A Health Affairs abstract is online.

ACP's press release is online.

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