Dr. Runge Presents NCMS Guiding Principles on Medicaid Reform to NC MCC

The NCMS was recently invited to present its views on Medicaid reform to the NC Medical Care Commission (MCC). The MCC develops regulations for health facilities and is a conduit for tax-exempt bond financing for non-profit health facilities in this state. NCMS Board member Jeffrey W. Runge, MD, made the presentation (PPT file) and answered questions from the MCC members on February 11, 2015. On February 18, the MCC issued the following statement on Medicaid reform (PDF).

NCMS Responds To Proposed ACO Program Changes

The North Carolina Medical Society’s (NCMS) ACO Task Force finalized their comments on proposed changes to the Medicare Shared Savings Program (MSSP) and submitted them to the Centers for Medicare & Medicaid Services’ (CMS) on Wednesday. Review the comments here.
Generally, the Task Force found CMS’ proposals to be a positive step to encourage more practices to participate in, and continue to participate in the MSSP, although there were some concerns outlined in the comments. CMS released the draft rule on the MSSP for Accountable Care Organizations (ACOs) on Dec.1, and proposed a number of modifications, including:

  • Allowing for an additional 3 year agreement period containing no downside risk but with a lower shared savings payment potentials (40 percent);
  • Adding a third track with prospective patient attribution and greater risk and savings potential;
  • Updating the Minimum Savings Rate and Minimum Loss Rate for Track 2 to mirror Track 1;
  • Changing the beneficiary assignment methodology;
  • Clarifying some ambiguities in the rule;
  • Improving data sharing and reducing administrative burden.


CMS Considers EHR Incentive Program Changes for 2015

From CMS Reports:
Responding to input from health care providers and other stakeholders, the Centers for Medicare & Medicaid Services (CMS) announced last week that it intends to engage in rulemaking to update the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs beginning in 2015. These intended changes would help to reduce the reporting burden on providers, while supporting the long term goals of the program.
The new rule, expected this spring, would address concerns about software implementation, information exchange readiness, and reflect developments in the industry and progress toward program goals achieved since the program began in 2011.
CMS is considering the following changes:

  1. Shortening the 2015 reporting period to 90 days to address provider concerns about their ability to fully deploy 2014 Edition software
  2. Realigning hospital reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other quality programs
  3. Modifying other aspects of the programs to match long-term goals, reduce complexity and lessen providers’ reporting burden

These proposed changes reflect the Department of Health and Human Services’ commitment to creating a health information technology infrastructure that:

  • Elevates patient-centered care
  • Improves health outcomes
  • Supports the providers who care for patients

This rulemaking is separate from the forthcoming Stage 3 proposed rule expected in early March. CMS intends to limit the scope of the Stage 3 proposed rule to the requirements and criteria for meaningful use in 2017 and subsequent years.
For help with EHR and meaningful use, contact the North Carolina Medical Society’s Director of Practice Improvement Terri Gonzalez or at 919-833-3836 x123. For more information about the EHR Incentive Programs, please visit http://www.cms.gov/EHRIncentivePrograms.

Have An Opinion on Virtual Credit Card Payments? Take This Short Survey

Over the last couple years, the issue of virtual card payments continues to come up due to the tactics some payers have used to pressure practices into accepting virtual credit cards for payment and the additional fees that result.
The North Carolina Medical Society (NCMS) has worked to raise awareness among medical practice staff, and advocate within the health IT industry for better regulation of virtual cards. The short survey below will help stakeholders better understand the various perspectives on the issue. Please take a moment to voice your viewpoint.
The survey was developed by the Workgroup for Electronic Data Interchange, or WEDI. It is a national entity composed of all stakeholders – providers, payers, clearinghouses, EMR vendors, banks, etc.
Complete the survey by visiting https://www.surveymonkey.com/s/virtualpaymentcard.  The survey will close February 12.

Want to learn more about improving quality in your practice?

Recently, the Centers for Medicare and Medicaid Services (CMS) set new timelines and goals to move more aggressively toward a physician payment system based on the quality of services provided to patients, not the quantity. This announcement provides even more evidence of the historic changes already underway and gaining momentum in our country.
The NCMS Foundation has partnered with the NC Quality Center to develop NCMS CQU (Clinical Quality University), which works with health care teams to arm them with the skills they will need to progress in this new health care environment. CQU sessions consist of a mix of face-to-face learning at the North Carolina Medical Society (NCMS) Center for Leadership in Medicine in Raleigh, NC, as well as webinars and distance coaching. Teams of three will work together to complete a quality-based project to implement in their work place during this year-long educational track.
For more information or to begin the application process, vist www.ncmedsoc.org/cqu. The deadline for CQU applications for the spring session is February 28, 2015.

NC Health Department Alert on Simulated Saline

The United States Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) currently are investigating multiple instances of simulated intravenous (IV) saline products being administered to patients. These products are not sterile and should not be injected in humans or animals.
Wallcur’s simulated IV saline solution, Practi-0.9 percent sodium chloride solution, was shipped to medical clinics, surgical centers, and urgent care facilities in numerous states, including North Carolina. In some instances, this product was administered to patients. Adverse events have been associated with these incidents, including multiple hospitalizations.
Wallcur initiated a voluntary recall of Practi-0.9 percent sodium chloride solutions on January 7, 2015. NC DPH has contacted all facilities identified as having received these products.
Read the Health Alert, which outlines what clinicians can do to ensure simulated saline is not administered to patients and what to do if you suspect it has been.

Flu Numbers Reach Epidemic Proportions


Latest Flu Information From NCDHHS:

Flu season in North Carolina has resulted in 90 reported deaths by early this month, and more are anticipated as the virus continues its spread. The following message is from Interim State Health Director Robin Cummings, M.D.:
Influenza activity has been widespread in North Carolina since late November. So far, the predominant virus circulating in North Carolina has been the influenza A (H3N2) virus. This strain is associated with more severe illness and mortality among the elderly.
Approximately two-thirds of H3N2 viruses characterized by CDC so far this season have not been well matched to the vaccine, meaning that vaccine effectiveness against these viruses may be reduced.

Historically, flu activity peaks in North Carolina around late January or February. However, during the past three seasons, and including this current season, we have seen earlier rises in flu activity.
Important factors to note about this season’s intensity are:

  • Flu activity has been higher this season than in recent years. Although activity seems to have peaked, flu will still be circulating at high levels in North Carolina over the next several weeks.
  • We have seen high numbers of deaths among the elderly and outbreaks in long-term care facilities reported this season. This is expected during seasons like this one in which H3N2 is the predominant strain.

For more details on the flu outbreak, visit www.flu.nc.gov/data.
Read the updated guidelines for prevention and treatment.

CMS Announces Deadlines to Report 2014 PQRS Data

Time is running out to avoid penalties in the Medicare PQRS program. What you report will determine your 2016 penalty status. To avoid the 2016 penalty, an eligible provider (EP) must report 3 PQRS measures in calendar year 2014. There may still be time to avoid this penalty by reporting quality data through a CMS qualified registry or EHR. More information on the PQRS requirements and reporting options are available on the CMS website. The deadlines for reporting 2014 quality data are as follows, as reported by CMS:

Reporting Method Submission Period Submission Deadline Time(All Times are Eastern)
EHR Direct or Data Submission Vendor that is certified EHR technology (CEHRT) 1/1/15 - 2/28/15 8:00 p.m.
Qualified clinical data registries (QCDRs) (using QRDA III format) reporting for PQRS and the clinical quality measure (CQM) component of meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 1/1/15 - 2/28/15 8:00 p.m.
Group practice reporting option (GPRO) Web Interface 1/26/15 - 3/20/15 8:00 p.m.
Qualified registries 1/1/15 - 3/31/15 8:00 p.m.
QCDRs (using XML format) reporting for PQRS only 1/1/15 - 3/31/15 8:00 p.m.
Maintenance of Certification Organizations (MOCs) 1/1/15 - 3/31/15 8:00 p.m.

In addition to the PQRS penalty, a Value-Based Payment Modifier (Value Modifier) will apply starting in 2016 to physician group practices of 10 or more eligible professionals (EPs). This Value Modifier will adjust Medicare physician payments based on a quality and cost assessment completed by CMS, relying on PQRS for quality data analysis. Therefore, physicians in practices of 10 or more EPs must meet 2014 PQRS criteria or face penalties in both the PQRS and Value Modifier programs in 2016.
To learn more about how you can act now to avoid these penalties, attend the upcoming NCMS-hosted Webinar on January 21 explaining how it is not too late to send in the data for 2014 and avoid the 2016 penalties. Watch the NCMS website and the Bulletin for details.
For questions, please contact North Carolina Medical Society (NCMS) Director of Health Policy, Jennifer Gasperini, 919-833-3836 X152 or the NCMS Director of Practice Improvement Terri Gonzalez, 919-833-3836 X123, or visit our Marketplace page to view an NCMS-approved vendor list.

CMS Accepting Suggestions for PQRS Measures

The Centers for Medicare & Medicaid Services (CMS) currently is accepting quality measure suggestions for potential inclusion in the Physician Quality Reporting System (PQRS) for future rule-making years. These measures are used not only for the purposes of the PQRS program, but additional value-based initiatives such as the Medicare Shared Savings Program and Value-Based Payment Modifier (VBPM). Having a deep understanding of these measures will be increasingly important, particularly as CMS continues to phase-in implementation of the VBPM to all physicians starting in 2017. To learn more about the call for measures, visit the CMS website.

We Know the Troubles You’ve Seen

In June 2013, NCMS already knew the transition from HP’s legacy Medicaid claims system to CSC’s NCTracks would present challenges for physicians across the state.  So in advance of the July 1 go-live date, NCMS launched its NCTracks Trouble Log, a straightforward web-based form designed to allow medical practices to report their problems to us with ease.
We didn’t realize at the time how critical this tool would become over the next six months, especially. In the troubled early days of NCTracks, our Trouble Log was flooded with responses, ranging from incredibly detailed accounts of system failures to desperate pleas for help. Physician practices, hospital systems, dentists, chiropractors and other provider types used the Trouble Log to share their experiences.
This data allowed NCMS to identify common problems with the system and report those to CSC and NCDHHS for resolution. It also allowed us to escalate urgent problems immediately and ensure that medical practices in dire need received immediate attention. To date the Log received 200 separate complaints involving thousands of doctors and patients.
Having served its purpose (and then some!) we are decommissioning the Trouble Log and removing it from our website, a year-and-a-half after its launch. Our NCTracks advocacy efforts, of course, will continue, as there are still many folks out there experiencing problems and many system improvements that CSC has forthcoming.  Please continue to notify us about difficulties you encounter by emailing or calling Belinda McKoy, NCMS Solution Center Coordinator, 919-833-3836 X142.