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No Rest for Battle-Weary Docs

 |  By jfellows@healthleadersmedia.com  
   December 11, 2014

Year-end accolades are making the rounds, but physicians can't afford to be distracted from efforts to repeal the despised sustainable growth rate formula, to fight a large commercial payer, and to fund the education of primary care doctors in rural areas.

As 2014 draws to a close, many of us take time to reflect on the year's events. Media companies are no different. On Wednesday Time magazine unveiled its annual Person of the Year. Time picked the Ebola fighters. I agree with that assessment (after all some of them work right here in my hometown of Dallas), and it's difficult to distinguish one person or one group as doing something notable, especially in healthcare.

That's why we have our HealthLeaders 20, an eclectic group of executives, researchers, nurses, doctors, and others, who are making a difference in the industry.

End-of-year lists are fun and can be thought-provoking, but they should not distract from more pressing issues that threaten physician reimbursements.

SGR Déjà Vu
As House and Senate leaders wrap up their lame-duck session in these last weeks of 2014, I can't help but recall that famous Yogi Berra quote, "It's like déjà vu all over again." That's because nearly exactly one year ago, physicians were asking Congress for a permanent fix to the Medicare Sustainable Growth Rate, just like they are today.

Another temporary "doc fix" was passed instead, averting the 21% cut in Medicare reimbursement. But, here we are, one year later and the American Medical Association as well as other groups, is still lobbying for a permanent solution.

"Before they dismiss this Congress, we want to get it done now," Robert Wah, MD, president of the AMA told me in November during the House of Delegates Interim meeting in Dallas. "We've made so much progress; so much work has been done to create that bipartisan/bicameral bill… we shouldn't lose that momentum and start over again."

One significant barrier that could get in the way of settling on a permanent fix before January is that Congress is not under the same pressure it was in 2013. A year ago, the 21% cut was scheduled to go into effect on January 1, 2014. The current patch doesn't expire until March of 2015.

With a new Republican-controlled Congress coming into power in January, lawmakers can expect to be lobbied hard to finally come up with some sort of solution to this perennial issue.

"It's very hard for physician practices to innovate so long as this uncertainty of a 21% cut is hanging over their hands," says Wah. "No business can make a significant plan when they look at a potential revenue cut in the 20% range."

Groups call on UnitedHealthcare to Back Off Pre-authorizations
In another corner, the College of American Pathologists, along with Florida chapter of the American College of Obstetricians and Gynecologists is fighting with insurer UnitedHealthcare over a policy to not pay for tests that are not pre-authorized or pre-notified.

It is slated to go into effect on January 1.

UHC is requiring doctors that participate in its Florida commercial HMO market to notify the insurer ahead of time when ordering some 80 tests. Two tests require pre-authorization.

Doctors complain the system disrupts their workflow, does not integrate well with commonly used electronic health record systems, and the list of tests do not follow evidenced-based guidelines of some medical societies.

The last issue may have the most legs because there is an increased focus on eliminating tests that are not seen as beneficial to patient care. The ABIM Foundation is aggressively pushing its Choosing Wisely campaign to physicians to make them aware of needless tests that do little more than increase cost of healthcare as well as anxiety for patients and their families.

More than 60 specialty societies, including ACOG, are working with the ABIM Foundation to endorse its stance on eliminating certain tests. UHC says its goal in narrowing its tests is to also improve patient care, quality, and cost.

Despite pressure from multiple physician organizations, UHC is standing by its policy, and if doctors don't comply, they will not get paid.

Idaho Docs to Lobby for Education Funding
States with large rural areas are often designated by the federal government as health professional shortage areas. In Idaho, all 44 counties are designated as HPSAs for mental healthcare, and 40 are primary care HPSAs.

The Idaho Medical Association will be lobbying its state lawmakers in 2015 to improve medical education funding and options to repay loans. The hope is that getting its medical residents to stay and practice will alleviate the shortage in some of the counties.

Idaho has a Rural Physician Incentive Program in place that helps doctors who practice in HPSAs repay medical education loans. The maximum amount a doctor can get for loan repayment is $50,000 over four years. IMA wants to increase the amount of money available and the number of physicians who participate, which is currently 10, according to the Idaho Department of Health and Welfare.

The organization also says that without more funding the state will have to reduce the number of residency slots, which would exacerbate the problem.

A new medical school just authorized by the Washington State University in Spokane could also help ease provider shortages. The University of Washington has the only publically funded medical school in the state and trains doctors from Idaho and other nearby states that also have federally designated HPSAs.

 

Supporters believe opening a new medical school will mean more medical school graduates who can serve the area. WSU's new medical school will focus on educating primary care physicians.

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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