The FTC warns seniors to hang up if they receive calls from individuals claiming to be from Medicare and asking for Social Security or bank information.
New Medicare cards will be mailed out automatically, starting April of 2018, and are free to all 57 million Americans on Medicare, the Federal Trade Commission (FTC) has reminded seniors in response to a new wave of scams related to the update.
The new cards—required under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015—will assign each beneficiary a unique, randomly assigned number, known as a Medicare Beneficiary Identifier (MBI), which replaces the current Social Security Number–based Health Insurance Claim Number (HICN).
The purpose of the change is to reduce identity theft.
But aiming to take advantage of misinformation and confusion among seniors during the transition, scammers are calling seniors and telling them that they must pay for their new Medicare card. According to a Reuters news service report, the senior that filed the complaint was asked for checking account information and Medicare card numbers.
The FTC has verified this report and tells beneficiaries: “Is someone calling, claiming to be from Medicare, and asking for your Social Security number or bank information? Hang up. That’s a scam.”
Physicians should use this transition year to take advantage of resources to help them comply with MACRA and get started if they haven't already, the AMA president says.
Although it's been just months since half of healthcare providers admitted stark lack of awareness, let alone readiness, to comply with Medicare Access and CHIP Reauthorization Act (MACRA), a key deadline for the law's merit-based incentive payment system (MIPS) track has already come and gone.
David O. Barbe, MD, MHA, a board-certified family physician and president of the American Medical Association, provides guidance on how physicians and medical groups can get up to speed.
HealthLeaders Media: Now that the October 2 deadline for 90-day participation in MIPS has passed, what's your advice to physicians?
David Barbe, MD: For 2017, if a physician hadn't started reporting prior to October 2, then they missed the opportunity to do what I call 'standard reporting.'
However, in our conversations with CMS in preparation for this first transition year, we were able to negotiate a fairly straightforward process where a physician can report on one patient and one quality measure, and that will exempt them from the penalty.
They don't get a bonus for that of course, but they don't get a penalty applied.
HLM: What are the main questions you have been getting from members about MIPS?
Barbe, MD: When physicians have questions, it's mostly around how to participate, which measures to use, and what's going to work for their practice.
So we have developed several tools and resources, including what's called a payment model evaluator, which lets the physician assess his or practice, where they stand in terms of readiness to participate fully, and what is the gap between where they are now and where they need to be.
We also have a MIPS action plan, which is an even more robust program that will help physicians track their progress toward being able to participate successfully in MIPS.
To get back to your earlier question: Now is the time to get ready for 2018. Now is the time to avail yourself of these resources, to go to the CMS website, and get ready to participate at some level in 2018.
We have to help physicians understand that this type of program—with emphasis on paying for value and quality, incentivizing continued use of the electronic health record (EHR), and making care model changes—is not going away.
HLM: Granted that the regulatory and administrative burden on physician practice is increasingly untenable, medical groups have historically been slow to prepare for regulatory changes. What's your message about being more proactive about compliance?
Barbe, MD: That's the reason that through essentially every outlet that we have to communicate with physicians, we've attempted to help them understand this, to not procrastinate, to roll up their sleeves and begin to gear up for these programs. And I think most of them have.
The biggest hurdle here is quite honestly the business case. What does it cost to gear up, to improve your EHR, to hire the extra personnel that are required, to do a new care model or collect the data, and report the data, etc.? That is all fairly resource-intensive and, therefore, costly.
And the incentives under the previous legacy programs were nonexistent.
HLM: Are MIPS incentives adequate?
Barbe, MD: At least now under MIPS we have an upside opportunity for those groups that perform well. But it's a zero-sum game or budget neutral, and that makes it difficult sometimes for a physician to get too excited about it.
They know that half of the physicians are going to be under a median or mean threshold of performance just by definition. That's the way it's designed to be structured.
The AMA has lobbied hard—and been successful so far—in getting CMS to use the flexibility it has as to where it sets the threshold. But that potentially goes away in the 2019 reporting year by statute, according to MACRA. So we will be gearing up to work with the legislature because we'll need some legislative changes to allow CMS to provide continued flexibility.
Physicians must ask patients about guns, counsel them on safe firearm behaviors, and take further action when an imminent hazard is present, ACP says.
Doctors from the American College of Physicians (ACP) are urging their colleagues to make a public commitment to talk with their patients about guns, emphasizing their call to action by inviting fellow clinicians to take an online pledge.
In the wake of the Las Vegas shooting that killed more than 50 people, Congress and the White House have abdicated their responsibility to address firearm violence, wrote Garen Wintemute, MD, MPH, from the Violence Prevention Program at UC Davis, in the Annals of Internal Medicine.
"But there is a critically important and beneficial action that we physicians can take, right now and on our own initiative," Wintemute added. "Fundamentally, it's quite simple. We need to ask our patients about firearms, counsel them on safe firearm behaviors, and take further action when an imminent hazard is present."
Furthermore, the notion that it's illegal for clinicians to ask patients about guns is a myth, he noted.
And physicians are well-positioned to intervene when there's a risk for gun violence, as evidence shows that people who commit firearm violence often have well-recognized risk factors, including:
Abuse of alcohol
Abuse of controlled substances
Acute injury
History of violence (including suicide attempt)
Poorly controlled severe mental illness
An abusive partner
Serious life stressors
"The relationship between fatal violence and recent contact with a health professional is clearest for people who commit suicide," Wintemute wrote. "As many as 45% have seen their primary care provider within a month of their deaths."
In an accompanying editorial, Christine Laine, MD, MPH, and Darren B. Taichman, MD, PhD, supported these ideas, emphasizing the need for physicians to educate themselves on the subject if necessary.
"Feeling uncomfortable about how to talk with patients about guns is not a reason to shy away," they wrote. "Read when and how to do it. Let's start now. Too many of our patients are in danger. This simply cannot wait."
"As with all public health crises, federal and state governments must thoughtfully deliberate and boldly act on the best ways to address and deter the increasingly deadly problem of gun violence in America," they wrote.
"NAEMSP urges Congress to advance bipartisan solutions and consider reasoned input from private industry and diverse stakeholders."
A simple communication technique used frequently in outpatient settings improves satisfaction for hospitalized patients, study finds.
When clinicians spend a few minutes communicating with hospitalized patients "as people," their satisfaction improves significantly, according to a study from the University of Virginia School of Medicine.
Used frequently in outpatient settings, a brief psychosocial intervention called BATHE (which stands for Background, Affect, Trouble, Handling, and Empathy), gives hospitalized patients the opportunity to share psychological or life problems as well as medical symptoms with their providers, who can then address those issues briefly and effectively, wrote UVA associate professor and clinical psychologist Claudia Allen, JD, PhD, and colleagues.
Their findings are published in the journal Family Medicine.
Moreover, the technique can be adjusted based on the amount of time available. "BATHE includes an entry and an exit script," Allen said. "You can spend three minutes doing it or you can spend an hour doing it."
Key highlights of the study include the following:
Patients receiving BATHE daily gave their doctors an average score of 4.77 compared with an average score of 4.0 for patients receiving standard care, which is a statistically significant difference.
There was no significant difference in the average score of BATHE and non-BATHE patients when they were asked to rate how much time they spent with their doctors.
Family medicine doctors reported that using BATHE didn't add significantly to the time they spent with patients; it just better focused their conversations.
Physicians also noted that patients receiving BATHE were less likely to seek extra attention from doctors or nurses out of anxiety.
"The beauty of the intervention is that it doesn't ask doctors to do anything radically different or add something totally extra," Allen noted. "It just tweaks what they're already doing to make it significantly more effective."
Jerry Penso, MD, MBA, plans to help medical groups face regulatory burdens, physician burnout, and increased consumer expectations.
The American Medical Group Association’s (AMGA) board of directors announced today that it has appointed Jerry Penso, MD, MBA, to the position of president and chief executive officer, effective October 16, 2017.
“New payment models, regulatory burdens, physician burnout, consolidation in the market, and increased patient expectations for convenience and service are just a few of the challenges our members face,” Penso stated.
“My aim is for AMGA to be our members’ preferred partner as they navigate the transition to value-based and high-performance health models. I’m committed to ensuring AMGA becomes an even stronger voice in changing and improving healthcare, and supporting our members in meeting the needs of patients. I look forward to bringing members and other stakeholders together for this important work,” he said.
Penso currently serves as president of the AMGA Foundation and chief medical and quality officer for the AMGA. He replaces Donald W. Fisher, PhD, CAE, who passed away in March 2017. Ryan O’Connor, MBA, CAE, AMGA’s vice president of membership and marketing has served as interim president and CEO since June 2017.
Prior to joining AMGA, Penso served as medical director, continuum of care for Sharp Rees-Stealy Medical Group (SRSMG), the largest integrated healthcare delivery system in San Diego.
In addition, Penso has served on the Integrated Healthcare Association Board of Directors, the California Cooperative Healthcare Reporting Initiative Executive Committee, and other prominent healthcare councils.
Patients should be screened and treated for substance abuse disorders before elective surgery is performed, researchers urge.
Post-operative pain is an accepted part of most surgeries, including elective operations. But in recent years, increased opioid prescribing has been closely linked to increases in opioid overdose, according to a special topic paper in the October issue of Plastic and Reconstructive Surgery®, the medical journal of the American Society of Plastic Surgeons(ASPS).
"Surgeon opioid prescribing practices contribute to the opioid addiction crisis," wrote Daniel Demsey, MD, of University of British Columbia, Vancouver, and colleagues. "Improvements in prescribing practices can improve patient safety."
The paper includes the following recommendations to help plastic surgeons become part of the solution:
1. Patients should be screened for risk factors for opioid use disorder, which include previous substance use disorders, mental health problems such as anxiety or depression, being female, and low socioeconomic status. Note that patients who have never taken opioids before can still be at risk of persistent use.
2. Physicians should talk to patients about the risks of opioid addiction and diversion in a nonjudgmental way and encourage them to use and store their medications properly.
3. Physicians should refer patients with known or suspected substance use disorders to an addiction specialist, preferably before surgery, and consider referral to a transitional pain service after the surgery and development of an opioid weaning plan.
4. Plastic surgeons should inform patients’ primary care doctors about possible increased risks linked to opioid prescriptions.
5. Consider the use of combination anesthesia techniques and prescribing nonopioid pain medications after surgery.
"Although we cannot solve the opioid addiction crisis on our own, as plastic surgeons we can make a major contribution,” Demsey said.
Don't change a thing about your physician compensation plans before taking these proactive steps.
Changing physician compensation plans is inherently difficult, but especially toilsome as reimbursement mechanisms continue to transition away from fee for service (FFS) and toward value-based care.
This evolution is manifesting more quickly in some U.S. markets, such as in the progressive Commonwealth of Massachusetts, where risk-based contracts are plentiful.
During a recent panel discussion hosted and live-streamed by the Massachusetts Medical Society's Physician Practice Resource Center, experts offered guidance to leaders looking to align their compensation plans with the way practices are getting paid.
1. Teach 'Value 101'
"Before you make radical changes, either operationally or as it relates to physician compensation, there needs to be broad education," said Eric Passon, founder and CEO of consultancy Ancore Health. In particular, employed physicians as well as their leaders need to understand the basics of how their organization makes and spends money under its current value paradigm.
Physicians should also be provided with insights into where a group's contracting strategy is going.
"There are a lot of things in the FFS world that are not really good for a hospital," he said. "Understanding that economic transition between point A and point B is critical."
2. Know What You Owe
Even though compensation linked to meeting certain metrics is often called a "bonus," physicians count on receiving it.
"The more metric-driven a comp plan, the more the program becomes, in the eyes of the law, essentially a commission. And a commission is considered to be wages," noted Valerie Samuels, a partner with Posternak Blankstein & Lund LLP in Boston.
"So at the end of the month or quarter or whenever that bonus money is given, it's not going to be discretionary," she said. "It's definitely due and payable, and the penalty for not doing so [in Massachusetts] is triple damages plus attorneys' fees."
To protect your practice in the event of a disagreement, Samuels urged practice leaders to have all compensation plans reviewed by counsel upfront. "Better to spend $1,000 making sure you're compliant than lose hundreds of thousands in litigation later," she said.
3. Do a Test Run
No matter how much due diligence goes into creating a compensation plan, unintended consequences occur frequently, noted Passon. But a trial or shadowing period before implementing a new plan fully can help iron out some kinks.
Importantly, this approach allows leadership to continue to build trust with physicians throughout the shadowing and implementation process, he said.
Investing the extra time in your physicians as a resource may pay off legally as well.
"Having done employment law for many years, I've observed that most lawsuits come from misunderstandings," Samuels said.
"When you're dealing with highly educated professionals, many of the problems come from miscommunication; lack of writing things down in a clear, coherent manner; or lack of buy-in."
PAs practicing in states with a practice barrier reported lower salaries than their peers in states without that barrier, according to a survey from the American Academy of PAs.
States with more progressive laws governing the practice of physician assistants (PAs) also offer the Masters-prepared clinicians the highest earning potential, according to the American Academy of PAs (AAPA) 2017 AAPA Salary Report.
The AAPA analyzed the survey responses of 7,225 PAs in relation to whether states have adopted the Six Key Elements of a Modern PA Practice Act, which include, “licensure as a regulatory term” and “adaptable collaboration requirements,” among other measures intended to ease barriers to PA practice.
In 2016, the median annual salary for PAs working full-time in the United States was $102,000, up 5.2% from a median of $97,000 in 2015.
The 17.3% of PAs who reported receiving an hourly wage, rather than an annual salary, earned a median of $60.00 per hour—a 9% pay increase over 2015.
In addition to their base salary or hourly wage, 48.4% of full-time PAs received a bonus in 2016. Half of these respondents reported a bonus of $6,000 or more.
The top median salaries were reported by PAs working in critical access hospitals ($111,000), operating rooms ($110,000), and intensive care/critical care units ($110,000).
The lowest median salaries were reported by PAs working at ambulatory service centers ($95,500), rehabilitation centers ($96,250), and extended care facilities or nursing homes ($95,000).
States with the highest PA base salary are those in which state-level enactments have reduced practice barriers. For example, the median salary in states that have adopted “adaptable supervision requirements” (28 and Washington, D.C.) was $108,799, compared to $101,475 in the remaining states.
In the 37 states in which PA clinical scope is determined at the practice level, the median PA salary is $107,178, compared to $104,145 elsewhere.
The 2016 survey also includes cost-of-living adjustment tools to help relocating PAs negotiate new salaries.
Physician practices may begin data collection as late as December 31 and still avoid the negative payment adjustment.
October 2, 2017, marked practices’ deadline to begin collecting data for the Centers for Medicare & Medicaid Services’ (CMS) “pick your pace” option two under the merit-based incentive-payment system (MIPS) track of the Medicare Access and CHIP Reauthorization Act (MACRA).
For this transition year of the Quality Payment Program under MIPS, practices can participate in one of three ways:
Submit data covering a full year
Submit data covering at least a consecutive 90-day period (avoid negative adjustment and possibly become eligible for a positive payment adjustment)
Submit a minimum amount of data (<90 days) (doctors may submit just one day of data to avoid a pay cut in 2019 for 2017 performance, but more data boosts odds of bonus)
Therefore, practices can begin data collection as late as December 31, 2017, and still avoid the negative payment adjustment, CMS advised. However, more data increases one’s likelihood of earning a positive payment adjustment.
Physicians must submit their 2017 MIPS performance data from January 2, 2018, to March 31, 2018. CMS will cut Medicare pay 4% in 2019 for doctors who do not submit data during that time.
Whether you are delivering primary care through a multi-state integrated system or a rural independent practice, benefits abound in optimizing this fully reimbursed Medicare service.
Despite primary care providers' celebration when the Centers for Medicare & Medicaid Services began paying for the preventive service now known as the Annual Wellness Visit (AWV) in 2011, the majority of PCPs continue to forgo those dollars.
But according to organizations that have made a concerted effort to promote and perfect the service, revenue is far from the only benefit of a strong AWV strategy.
Success key No. 1: Educate providers
Nationally, in 2016, 19.8% of eligible Medicare Part B beneficiaries utilized the AWV, according to a CMS report, despite the fact that CPT codes G0438 for the initial visit and G0439 for a subsequent AWV are paid 100% by Medicare and can be combined with another visit with the addition of a modifier.
The barriers to higher uptake are mostly cultural.
In particular, there is a common perception among physicians that the service is unnecessary.
"A lot of folks seem to feel that they're already meeting the need that's intended by the AWV without needing to do a distinct service," says Dan Hager, MHA, program manager for physician and ambulatory services for Bon Secours Health System.
Doctors often argue, for example, that the questions raised in the AWV about recommended cancer screening and immunization are already raised during the course of regular primary care, says Hager.
Oftentimes, providers also experience or fear seniors being dissatisfied with coming to the office for a visit that involves no physical exam.
"An important first step was just getting physicians acquainted with what it was," Hager says. "After that it was really about removing as many impediments as possible to getting it done."
For Bon Secours, this meant developing a complete toolkit that explained what should be included in an AWV, how to bill for it, and when and why a copay might be required.
"The toolkit started as an internally developed communication outlining the reason for prioritizing the AWV as well as a summary of the documentation requirements and tips for coding the visit. It also included some tools available from the CMS Learning Network and others including potential workflows, scripts, explanatory articles, and other tips," Hager says.
As the toolkit developed, Hager says Bon Secours relied more on its internally developed documents based on its experience and identified best practices.
"This included education on coding, the EHR workflows we developed, a scheduling/registration workflow, and scripting to encourage our patients in the office and over the telephone to get an AWV," he says.
Thus, consistent, systemwide communication was important in Bon Secours boosting its own 26% AWV rate to approximately 65% within three years. "Critical to this success was talking about it, communicating, and explaining our strategic initiative in terms of driving population health outcomes," Hager says.
Today, Bon Secours AWV progress continues, with about 61% of eligible patients getting the visit and high hopes for reaching 65% by fall of 2017.
Success key No. 2: Engage patients
For South Arkansas Medical Associates, a six-physician primary care practice in rural El Dorado, persuading its doctors and advanced practice clinicians to perform AWVs wasn't nearly as challenging as selling patients on the idea, says Pete Atkinson, MHA, the group's administrator.
"When Medicare first started to allow AWVs, we kind of dabbled in it. From a flow standpoint we struggled, and a lot of that was getting patients to come in specifically for that wellness visit," he says. "For that generation, it's a new thing. To them, you go to the doctor when you're sick. It doesn't make sense to them to come to the doctor when they feel fine."
SAMA has found much better success in scheduling AWVs in conjunction with other follow-up and acute visits, he says. Patients who come in for a diabetes follow-up visit, for example, can undergo their AWV the same day.
"Fall of 2015 is when it started ramping up," Atkinson says. And having joined an ACO last year as well as participating in CMS' Comprehensive Primary Care Plus (CPC+) program, the practice is now conducting the visits with nearly 60% of its Medicare patients.
For many seniors, especially those with transportation problems, the twofer visit has a social appeal as well.
"It's their chance to get dressed and get out of the house. And if they're coming on one of the senior buses they get to visit with peers," says Gary Bevill, MD, a founding member of the practice. "They seem to appreciate the fact that they're not just in and out for a so-called eight-minute visit."
And now that many patients have participated in one or two recurrent AWVs, their engagement in their overall health seems to be on an upswing, says Bevill.
For example, Bevill describes a patient who recently visited the office with her husband, and apologized for not bringing with her the printout of recommended screenings from her own recent AWV, on which she'd diligently filled in all of the test dates and results.
"She didn't know that I'd gotten the results, but she was going to bring the form back so we could update our system," he says. "Again, she didn't realize that we're already updating it, but this is a senior with a lightbulb going off—see? That to me felt like maybe we're making some inroads," Bevill says.
Success key No. 3: Take a team approach
On the flipside of these successes can be the challenge of maintaining the capacity to provide increasing initial and recurrent AWVs, notes Hager.
"Now that we're in our fourth year of focus on this … and the number starts to climb higher and higher, it highlights for us some of the areas where we have challenges when it comes to patient access," he says.
The system's next areas of focus, therefore, are "expansion of the infrastructure, coming to grips with our overall access, and exploring how we use the AWV as part of an overall strategy for engaging patients and earning their loyalty."
SAMA has had to work out its share of flow and capacity challenges as well, Atkinson says, but many have been solved by implementing staff ideas.
"We turned a lot of it over to the nurses and care coordinators. In particular, our population health nurse and IT nurse came up with a lot of the flow," says Bevill. "I think if you talk to some of our employees they're pretty happy campers because they feel like they have input. And if something is not working, they can suggest an alternative."
For example, care coordinators will often call patients before their AWV and ask several screening questions then, Atkinson says. "So when they come in, it's a shorter time in the clinic. That's been a huge help."
But even a full AWV takes an average of 30 minutes total, he says, only about 5 minutes of which involves the physician. "Most of it is done by the nurse."
Another key to efficiency is that care teams review a patient's EMR prior to any visit and know of any issues, such as an elevated A1C level, before walking into the room, notes Bevill.
The nurse is fully prepared by the time she gets the patient out of the waiting room, and reviews the recommendations with them while walking back out.
"It doesn't take a ton of my time," says Bevill, "but I reinforce the fact that as your doctor I want you to have these tests, and they usually go along with it."
Success key No. 4: Connect to quality
With an average reimbursement of $172 for an initial AWV and $111 for subsequent AWVs, the revenue can add up for primary care practices of all sizes.
But the value is best measured in terms of benefit to the patient, says Hager.
"It was incredibly important that it not be about the money so much as it was about the value that we were driving for our patients, for our community, and even for our payer. CMS is asking us to be good stewards by making this available, and we want to make sure we're delivering the aims they intended when they created the opportunity to do an AWV."
Indeed, Bon Secours' own data has revealed that patients who get AWVs are also dramatically more likely to follow through on other preventive services.
For example, while the causal relationship is unclear, Bon Secours' Medicare beneficiaries who had an AWV in 2015 were significantly more likely to receive breast cancer screening, colorectal cancer screening, pneumonia vaccination, and influenza vaccination.
While just 53.6% of patients older than 66 without an AWV got a pneumonia shot, for example, 84.5% of those who attended an AWV were immunized, Hager says.
"A lot of folks seem to feel that they're already meeting the need that's intended by the AWV without needing to do a distinct service."
And although SAMA has not run such comparisons, Bevill notes that the practice is on track to conduct foot exams for 85%–90% of the group's diabetic patients whether they've had a wellness visit or not. "We're seeing a huge jump in our quality metrics on all of our patients," he says.
Perhaps that's because the practice has reinvested most of the revenue collected from AWVs into its overall quality initiatives.
"Having been in solo practice for 15 years and here for 19 years, [I know] PCPs are always looking for ways to increase revenue," says Bevill. "But we're also a CPC Classic and now a CPC+ clinic."
Participating in those initiatives has involved significant growth. In 2012, for example, the practice had four physicians, two advanced practice nurses, and less than 30 employees. Today, SAMA has 14 providers and 74 employees.
"And that has a cost," Bevill says. "While the Medicare wellness visit does generate an increased revenue stream, we have turned around and invested that revenue into the additional staff it takes to do population health."
Success key No. 5: Celebrate success
With the wrinkles ironed out, AWVs can also have a positive impact on providers and employees.
At Bon Secours, for example, the systemwide AWV initiative helped strengthen its network relationships.
"It was actually very well timed because we'd been in the midst of a primary care growth strategy to rapidly increase the amount of PCPs we had in our communities," Hager says. "The AWV came around the mid-point of that growth effort and provided a great opportunity for us to establish an identity across all of our diverse providers in the practices and give us something we could all work on to get there."
Meanwhile at SAMA, job satisfaction is on the rise in an era when clinician burnout has become epidemic.
"The doctors and APNs—we love coming to work," says Bevill. "It is so much easier to take care of these chronic, complicated patients with the system that we have put in place. That's made it worth every penny."
