Posts tagged with ama

All the RVU drama makes it hard for me to get to other things, but here is the latest from my generous and favorite inside source (instead of using an inappropriate 70s adult film nickname, we'll use "Siouxsie"):

1) The new CF for 1/1/08 through 6/30/08 will be $38.0870 [= 0.5% increase from the current CF of $37.8975; what happens after that point is anyone's guess] 2) The work GPCI floor (1.000) will be maintained through 6/30/08 [again, what happens after that point is unknown] 3) The bill did NOT include provisions to "alter or supplant the role" of the RUC

Attached with this cogent explanation was a memo straight from Michael Maves, the E-VP and CEO of the AMA. Now, let's all be tense for six months. Ready? Go! [I can actually update the RVU calculators, now.] Wow, Siouxsie kicks butt and sends me this important AMA Memo about the changes 2 minutes after I post this.

I am feeling a little like the Winooski River, when it freezes over and then dams up, causing the water to overflow the banks and wreak havoc locally.

Update: The AAP is no longer alone, as the AMA has issued a letter to ABC. And life wouldn't be in balance if the Immunization Action Coalition didn't weigh in as well!

I probably shouldn't frame this issue as a "vs." smackdown, but it makes for an easy title. Plus, if the conversation on PedTalk about this (and from what I've heard from SOAPM) is any indication, perhaps I'm not exaggerating. The AAP has issued a request to ABC that it run a disclaimer during an upcoming episode of the show "Eli Stone" in which "...the title character successfully argues in court that a vaccine caused a child's autism." Here it is in their words:

Anne Sweeney
President, Disney-ABC Television Group
47 W. 66th St.
New York, NY 10023-6290
Dear Ms. Sweeney:
According to The New York Times, ABC plans to run an episode of "Eli Stone" in which the title character successfully argues in court that a vaccine caused a child's autism. The American Academy of Pediatrics (AAP), an organization of 60,000 pediatricians, is alarmed that this program could lead to a tragic decline in immunization rates. The AAP calls on ABC to cancel the episode.

Many people trust the health information presented on fictional television shows, which influences their decisions about health care. In the United Kingdom, erroneous reports linking the measles vaccine to autism prompted a decline in vaccination and the worst outbreak of measles in two decades, including the deaths of several children.

ABC will bear responsibility for the needless suffering and potential deaths of children from parents' decisions not to immunize based on the content of the episode. If ABC persists in airing the show, the AAP urges the network to include a disclaimer emphasizing: No mercury is used as a preservative in routinely offered childhood vaccines. No scientific link exists between vaccines and autism.

Vaccines are the single-most powerful, cost-effective public health intervention ever developed. A network as influential as ABC must consider its responsibility not to promulgate messages that undermine the years of efforts by the AAP and public health community to persuade parents to vaccinate and protect their children. The consequences of a decline in immunization rates could be devastating to the health of our nation's children.

Sincerely,

Renee R. Jenkins, MD, FAAP
President

I don't know if the show in question is will be any good, but the description of it doesn't make clear how they actually derive a series from the premise. I've read a couple of the Autism blogs screaming about this - I'm not going to give them links - and it just goes to show again how a small, hyper-vocal number of people can really taint an issue. I've seen two references to the letter above as "hysterical" (as in "crazed" and not "funny").

What I wonder is if it would be better for the show to run, but with a good presentation about the science at the end? Sometimes, and I know I'm not alone, I think the AAP should purchase advertising on TV and speak directly to the public on matters like this.

If you would like to voice your concern about this episode, let ABC know here.

Now here's a combination of topics that no one will ever look for. I don't know, for "search engine optimization purposes" whether mixing two items like this is better or worse than writing two quick blog pieces (and pushing content further down the page or into the archives), but I won't worry about it.

First, many of you have noticed that the traffic on PedTalk and the SOAPM lists had died off for about two weeks. You can see why here:

http://web.mac.com/jsstoller/iWeb/Site/2008%20OCI%20Mission.html
http://web.mac.com/jsstoller/iWeb/Site/End%20of%20mission%20fun.html

...this what Drs. Stoller and Lessin were up to from Mar 6 to Mar 19 - their medical mission to Ghana.

Second, some of you are aware of the fight we have had with the AMA over our RVU calculators. You'll notice that this one only contains a subset of the codes (the most important pediatric ones) and this one requires you download the codes yourself. Their argument was that, due to their copyright of the CPT codes, no one is allowed to publish any more than 30 CPT codes (and the accompanying RVU values). We didn't have the $$ to fight them, so no more free RVU calculator that doesn't require you to download the codes yourself. Anyway, I have enjoyed making a collection of WWW sites that publish full RVU/CPT values. The problem is that I keep finding them everywhere. There are literally dozens, if not hundreds, more. I wonder why the AMA has time to threaten PCC with a lawsuit and not all these folks? [Hint: it has to do with Ingenix losing money.]

They usually write themselves.

Reason #1156 to pay attention to Susanne Madden and the Verden Group - the AMA itself has turned to her for an analysis of the exodus of patients from many of the large, national plans. Apparently - based on the quote above, from Wellpoint's CEO - the insurance companies are more interested in their short-term bottom lines than anything else.

For the record, NO this isn't a surprise and YES we realize that these are businesses and exist to make money. Perhaps insurance companies shouldn't be publicly traded? The president of the AAFP wonders, too:

"They have a problem in that they are for-profit corporations. They've got to answer to their stockholders and look for profit," he said. "At the same time they do have a responsibility to society. They need to make sure they are working together to make sure as many people are insured as possible by holding down premiums."

Oh, what does this have to do with Susanne? I love her quote:

"With consolidation and there being fewer players comes a certain amount of arrogance," she said. "The response from the insurers is quite miserly."

I love that word, "miserly." Didn't Ebenezer Scrooge change his ways, in the end? When does the Ghost of Healthcare Future show up and scare us all? Go read the piece and save it in your "Next Time We Negotiate" folder. I wonder if this is a warning to practices that they aren't going to care as much if you drop them?

I don't know how I missed this announcement (thanks, Bob @ PhysAll), but the AMA has embarked on an advocacy campaign specifically targeting the baloney that goes on during the insurance claim submission process. Now this is the kind of work I want to see the AMA doing (instead of restricting the rights of its members and public to use CPT codes and RVUs).

First, check out the home site here. People who like to skip the instruction manual and jump right in, should read the amazing payor report card! I have only two gripes (limited list of payors, small sample size), but their chosen metrics really look great. Did you know that in the 134K payments from UHC analyzed in Feb/Mar in this report, UHC only allowed the proper amount...61.55% of the time? Amazing data.

The AMA also includes an appeal toolkit and pretty good "interactive document" (my favorite part) designed to help you appeal your claims. Though I'm not usually the AMA's biggest fan, this is an excellent start. Good work by them. Between this report card and the one from the Verden Group, you should have plenty of fun at your next insurance sit-down.

We've been hearing about this bogeyman for years, and CMS has finally made the announcement. From the Coder's Pink Sheet, we have this summary:

The proposed rule for ICD-10, which would replace ICD-9-CM, was released August 15 by the Department of Health and Human Services (HHS).

Also on August 15, HHS proposed an updated standard for electronic transactions for claims and prescription drugs. This standard, called Version 5010, (Version D.0 for pharmacy) is essential to the use of ICD-10.

Almost 30 years old, ICD-9 can't accommodate the burgeoning new diagnoses and procedures. There are 17,000 codes in ICD-9 and more than 155,000 in ICD-10. The new codes will facilitate electronic health records as a part of the electronic transactions.

Updated HIPAA electronic transaction standards will require the use of ICD-10 codes. The current standard (Version 4010) can't accommodate the higher volume of codes.

o Compliance with updated electronic transmissions (Version 5010 and Version D.0) would be required by April 1, 2010, under that proposed rule.

o Compliance with the new ICD-10 code sets would be required by two years after the final rule is published.

Both regulations may be viewed at:

www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp#TopOfPage.

Comments on the ICD-10 code sets proposed rule are due by 5:00 p.m. Eastern time on Oct. 21, 2008.

Comments on the updated transaction standards proposed are due by 5:00 p.m. Eastern time on Oct. 21, 2008.

Fact sheets describing both proposed rules will be forthcoming at http://www.cms.hhs.gov/apps/media/fact_sheets.asp.

The AMA released a very similar announcement.

The MGMA has already followed with a "why this is a bad idea" response.

My quick take on this is simple: we need to stop accepting such ridiculously low standards in our medical system here in the US. The ICD-10 is a lot like the metric system: it makes a lot more sense than our existing, archaic system; the rest of the world uses it; we're going to fight it foreve simply because we fear change and the existing system benefits the big cats.

Personally, I welcome our new ICD-10 overlords.

Meanwhile, I don't expect that this date will actually hold, but if it does...be prepared for a major hiccup when it does, as the inscos have no motivation to do this right.

I forgot to mention last week that I updated the Build Your Own RVU calculator for 2009.  You can find it and the instructions in the PedSource library.

To make a long story short, for those who don’t know it - I really don’t like the fact that do do any proper RVU analysis of your practice, you have to pay for expensive software.  Especially for software owned by organizations who have admitted to ripping off the very people they claim to serve.  So, I designed a free tool that, using the license for which you are granted permission to access CPT codes (thanks, greedy AMA), you can do the calculation work you need.

Share and enjoy.  Flash-based pediatric coding tool coming soon, I hope.

I know it's overdue, but it's worth the wait.

Introducing the 2011 BYORVUC - or, the "2011 Build Your Own RVU Calculator."  As you may know, the AMA won't let anyone provide a free RVU calculator due to their CPT copyrights.  In an abundance of caution and, because in our unhappy experience, the American Medical Association interprets its rights (in our opinion) overly broadly, we created this tool nly for those of you who have a CPT license that allows for a use such as this. 

To make a long story short, you can use this spreadsheet with the data that you can download from CMS to make a fairly sophisticated RVU calculator in about 5 minutes.  

What does it do?  It allows you to choose your CMS-driven location, set a Medicare Multiplier, and then, on a code-by-code basis, determine your pricing level.  If you then take the time to include your code volume and pricing, it will determine your practice's FACF (i.e., how much you charge, on average, relative to Medicare).  If you then provide your payment information, it will compare it to the Medicare fee schedule for you.  

All around, pretty cool I say in all immodesty.

I have created both an OpenOffice version of the tool and, sigh, a Microsoft Excel version as well.

How does it work?  

1.  Download one of the above spreadsheets.
2.  Head to CMS and download the 2011 RVU zip file.  You have to agree to the license and usage rules from CMS, of course.  My link above points to version A in 2011; CMS usually releases a few revisions through the year, but they usually don't affect pediatrics and primary care.
3.  Extract the PPRRVU11.xlsx file from the zip file.  Yes, I think it's completely lame that our federal government uses a proprietary format for this data, especially one (the new .xlsx) that not everyone who even owns Excel can open.  Grrrrr.
4.  Cut and paste the entire page of data from the PPRRVU11.xlsx file into the tab marked "PPRRVU11" in the RVU Calculator spreadsheet.  Don't panic if it seems to freeze for a minute, it's a lot of data.
5.  Choose your locality with the pulldown menu.  Pick a Medicare Multiplier. Then, enter some CPT codes in column A.  Gasp in amazement.
6.  Put some unit volumes, prices, and payments in and watch what happens.  Any field marked in a light blue-gray is a place where you can enter info.

I'd love for some guinea pigs to try this out and tell me what doesn't work.  PCC clients, natch, can do this already with our reports, so I want to hear from the rest of you :-)