AANA Federal Government Affairs
HOTLINE
Number 2005-10, Week of Monday, May 09, 2005
In This Issue:
* NPs Invited to Complete Web-Based Survey on Selected CPT Codes
* New Budget Resolution Could Cut Medicare Physician Fees
* CMS Says Pay-for-Performance Pilot Program A Success
* CMS Drops Resolution of Split Billing From Priority List
* House Democrats Lay Out New Healthcare Agenda
* Updated CERT Program Article Published
* Amendments
>> NPs to Complete Web-Based Survey on Selected CPT Codes
The AANA is sharing with CRNAs an invitation from ANA, in its observer role to
the body that advises CMS on physician payment (the AMA Relative Value Unit
Committee or AMA-RUC), to participate in an online survey about reimbursements
for certain evaluation and management (E&M) codes. According to Lee Broadston, a
member of the AANA Anesthesia Payment Advisory Panel (APAP), "CRNAs do need to
use these E & M codes from time to time and do have great difficulty in
receiving reimbursement from all payers for these consultative services."
Every 5 years, CMS is mandated to review the value of the CPT codes and make
needed adjustments. This year, CMS has identified E&M codes for review due to
perceived changes in patient populations. ANA is partnering in a
multidisciplinary coalition to survey the codes, analyze the data for changes in
work, and recommend new work values.
It is important that nursing data be included in the analysis of the E&M codes,
therefore AANA members' participation is critical. ANA is now
recruiting experienced nurse practitioners, familiar with the services
represented by the CPT codes, to participate in a web based survey for
the E & M codes.
There are requirements for participation.
To learn more and/or participate, contact Sheila Abood (sabood@ana.org),
indicating interest in participating in the E & M survey. Provide the following
informationname, address, phone, email, specialty, and practice setting (i.e.:
independent practice, academic setting, group
practice, HMO).
>> New Budget Resolution Could Cut Medicare Physician Fees
Following Congress' approval of a federal budget resolution that calls for a $10
billion reduction in Medicaid funding over five years, Washington is turning to
Medicare because of the "way the budget document is structured" (CongressDaily,
5/2). The budget resolution
calls for reductions to Medicaid but states that lawmakers can enact savings in
any mandatory spending programs under their jurisdiction -
including Medicare -- to achieve their designated funding-reduction targets.
Medicare reimburses CRNAs based on the physician fee schedule
and have an interest to ensure that Congress acts to reverse projected 5 percent
Medicare cuts before they take effect January 2006.
Both the Senate Finance Committee and the House Energy and Commerce Committee,
oversee Medicare for the Senate and House and must find $10 billion and $15
billion in total savings, respectively. They could choose to look to Medicare
physician fees as a source of savings. Some lawmakers would like to increase
physician reimbursement payments, which are slated to decrease by 5% annually
through 2012 after the current fee schedule expires in 2006. In addition,
hospitals could be targeted for Medicare cuts, although the House Ways and Means
Committee, which oversees Medicare hospital insurance, needs to find only $1
billion in savings (CongressDaily, 5/2).
Read budget resolution brief,
http://nationaljournal.com/cgi-bin/ifetch4?ENG+AMERICAN_HEALTHLINE-_-POLL_TRACK-_-AD_SPOTLIGHT+7-ahlindex+1123168-REVERSE+0+1+1358+F+3+6179+1+budget
Read more,
http://www.washingtontimes.com/national/20050429-124415-9959r.htm
>> CMS Says, "Pay-for-Performance Pilot Program A Success"
On Tuesday (May 3rd), Centers for Medicare and Medicaid Services (CMS)
Administrator, Mark McClellan, MD, PhD, announced at the American Hospital
Association (AHA) annual meeting the preliminary results of the Premier Hospital
Quality Incentive Demonstration project, a Medicare pay-for-performance pilot
program. The AANA has long supported patient safety. The first year of the
three-year pilot program, which tracks the performance of 270 hospitals on 34
measures of care for five conditions, shows "that the lure of higher payments
goaded hospitals into improving their quality of care." The program so far has
found "improvements across the board" (CQ HealthBeat, 5/3). The program offers
the highest-scoring hospitals bonus payments totaling $21 million over three
years. Low-performing hospitals could receive a 2% reduction in Medicare
payments at the end of the demonstration (Wall Street Journal, 5/4).
That same day (May 3rd), the Ambulatory Quality Alliance, a coalition of
physician, health plan and government groups, announced 26 quality measures that
health plans, employers and physicians could begin using to measure and improve
care quality. This includes preventive measures such as vaccinations, prenatal
care and cancer screenings; treatment of chronic conditions, including coronary
artery disease, heart failure, diabetes, asthma and depression; and two measures
addressing care efficiency (CQ HealthBeat, 5/3). The quality measures could help
health plans establish pay-for-performance systems as soon as next year. The
effort seeks to help physicians improve their quality of care, as well as make
measures "uniform and consistent" among insurers (Wall Street Journal, 5/4).
Read more from CMS,
http://www.cms.hhs.gov/media/press/release.asp?Counter=1441
To View All of the Pay-for-Performance Initiatives,
http://www.cms.hhs.gov/media/press/release.asp?Counter=1343
>> CMS Drops Resolution of Split Billing From Priority List
Nearly a year after a tentative agreement between the AANA and the American
Society of Anesthesiologists (ASA) on just how to bill for a
case that begins as medically directed and ends as personally performed, the
deal has faltered on who employs the CRNA, reports the Anesthesia Answer Book
(May 2005). CMS officials are so far refusing to budge on extending the relief
fix to non-anesthesiologist-employed CRNAs. Meanwhile, according to William
Rogers, MD, Director of CMS' Physician Regulatory Issues Team (PRIT), the AANA
has apparently lost interest in resolving the issue. "That's not true," says
Frank Purcell of the AANA Washington Office, "AANA is still committed to
resolving this issue. It's just working out these technical details so there are
no unintended consequences" (Anesthesia Answer Book, 5/05).
Read more about the PRIT at,
http://www.cms.hhs.gov/physicians/prit/
>> House Democrats Lay Out New Healthcare Agenda
On Wednesday (May 4th), House Democrats outlined a healthcare agenda that will
seek to legalize the reimportation of prescription drugs from abroad, allow
Medicare to negotiate directly with pharmaceutical companies for discounts on
medications and extend health insurance to more US residents (Las Vegas Sun,
5/3). If enacted, a longshot in a Congress in which Republicans are the
majority, the proposal would make more individuals eligible for the Medicare
program, and thus expand the influence on CRNAs of the Part B physician fee
schedule. In addition, the Democratic legislators' agenda will seek to provide a
50% tax credit to help small businesses and the self-employed purchase health
insurance, potentially affecting self-employed CRNAs or those who own groups,
and extend coverage to 7.5 million low-income working parents whose children are
enrolled in the SCHIP program.
Read more,
http://www.lasvegassun.com/sunbin/stories/bw-cong/2005/may/03/050307423.html
>> Updated CERT Program Article Published
On Monday (May 2nd) a Special Edition Medlearn Matters article was published by
Medicare regarding CMS' Comprehensive Error Rate Testing (CERT) Program. The
purpose of the CERT program is to measure and improve the quality and accuracy
of Medicare claims submission, processing and payment. A sizeable portion of
CRNA care is billed through the Medicare program. CMS uses this information to
address the error rate through appropriate educational and interventional
programs.
A key component of the CERT program involves providers submitting supporting
documentation for claims when requested to do so by CMS. The link below (SE0526
- CMS Comprehensive Error Rate Testing (CERT) Program - The Importance of
Complying with Requests for Claim Documentation) provides an overview of the
CERT program and stresses the importance of providing the requested medical
documentation for the CERT review.
Read the article,
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0526.pdf
>> Amendments
* The House and Senate will be in session this week. The House will be taking up
the Faster and Smarter Funding for First Responders
Act of 2005 (HR 1544), while the Senate will be focusing on the Transportation
Equity Act: A Legacy for Users (TEA-LU) (HR 3), sent over
from the House. News reports indicate the Senate is headed for conflict over how
the body considers judicial nominations.
* Representative Ted Strickland (D-OH) will not seek re-election. Congressman
Ted Strickland announced recently that he would not seek
reelection to the House of Representatives in 2006. Instead, however, he will be
seeking the Democratic nomination for the gubernatorial race in Ohio.
* Happy Nurses Week! This week (May 6th-12th) is National Nurses Week. Read more
at http://www.ana.org
* For up-to-date Congressional floor & committee schedule information, see
http://thomas.loc.gov/.
>> For More Information
The AANA Federal Government Affairs Hotline is published for the nurse
anesthetist members of AANA each week Congress is in session by the AANA Office
of Federal Government Affairs, Washington DC, 202-484-8400,
info@aanadc.com, Frank Purcell, Senior
Director. C 2005 American Association of Nurse Anesthetists
(posted 5-22-2005)