Insider - December 7, 2007 | Wisconsin Medical Society

FEDERAL UPDATE

Another year, another Medicare reimbursement cut?

In what has become a disturbing holiday tradition, Congress is struggling over how to prevent a looming physician reimbursement cut for providing treatment to Medicare patients. The combination of a flawed Sustainable Growth Rate (SGR) formula and Congress’s string of temporary annual fixes means that without Congressional intervention, Medicare reimbursement will be cut 10.1 percent January 1, 2008.

Adding to the troubles: Health and Human Services Secretary Mike Leavitt recently sent this letter to Senate Finance Committee Chair Max Baucus (D-Montana) stating that President Bush might veto any bill that prevents the 10 percent cut at the expense of Medicare Advantage programs. Sec. Leavitt provides his justification for the letter in his blog. He also expresses his belief that any Medicare reimbursement increases for physicians should be tied to adopting electronic medical records; he does not provide a plan for how to pay for that, however.

The Society has been participating in strategy sessions with the AMA, which clearly believes the time has come for an end to temporary solutions to the SGR problem. Instead Congress should be urged to scrap the SGR and properly fund a physician Medicare reimbursement strategy that at least keeps pace with the increasing costs to provide that care. As a high-ranking AMA staff member said on a recent conference call, “Congress needs to fix the problem, not grow the problem.” The Society’s Executive Committee recently met on this issue and agrees.

What You Can Do: Call your federal legislators and ask them to prevent the 10.1 percent cut in Medicare by funding a sensible plan that eliminates this annual problem. To find contact information for Senator Kohl, Senator Feingold and your U.S. House member, click here. Ask them to fix the problem before they adjourn for the holidays.

In the meantime, the AMA has issued this white paper on Medicare participation options for physicians. Those who wish to change their participation or non-participation status must do so by December 31, 2007.

Please contact Mark Grapentine if you have questions about this issue.

Comments solicited for ‘behind the counter’ drug proposal

The Food and Drug Administration (FDA) is soliciting comments on the public health implications of making certain drugs available behind the counter (BTC) that are currently available by prescription. If the FDA adopts a BTC program, a prescription from a physician for certain medications would no longer be necessary. Pharmacists would have the role of ensuring that patients meet certain criteria prior to dispensing the drug and would also have responsibility for providing patient education on proper use of the medication and monitoring.

The FDA is seeking written comments on specific BTC issues such as the feasibility of implementing a BTC program, the likely impact on patient access, impact on patient compliance with drug therapy, criteria or standards for designating certain drugs as BTC, potential cost effectiveness of a BTC program, the impact on patient safety and other issues. To view the complete list of questions, click here to review the Federal Register, Vol. 72, No. 192 (October 4, 2007).

The FDA must receive all comments, submitted electronically or as hard copy, on or before December 17, 2007. To submit comments electronically, click here. You may fax written comments to the FDA at 301.827.6870 or mail them to Food and Drug Administration, 5630 Fishers Lane, Room 1061, Rockville, MD 20852.

All comments should include the agency name and docket number (2007N-0356). To view the FDA’s submission instructions regarding comment submission, click here to review the Federal Register, Vol. 72, No. 227 (November 27, 2007).

STATE UPDATE

Society dismisses the Fund Board from its lawsuit

The Wisconsin Medical Society’s lawsuit against the state for raiding the Injured Patients and Families Compensation Fund (Fund) is ongoing. Since the Society filed its lawsuit on October 29, the Society and its litigation counsel have learned that the Fund Board was not involved in the action to transfer the money to the state. Therefore, the Society's Executive Committee voted unanimously to dismiss the Fund Board and Commissioner Sean Dilweg from the Society’s pending lawsuit. The Commissioner and the Fund Board were named as defendants because of the statutory language that requires Board approval for the withdrawal of money from the Fund. However, the state bypassed the Fund Board when it transferred money from the Fund. You can read the Society’s press release here, and if you have questions, please contact Ruth Heitz, JD, at 608.442.3741.

State Capitol churning through bill backlog

With the long-delayed biennial state budget completed, state legislators are engaged in a flurry of activity on general session bills that had been set aside during the budget negotiations. The Society is monitoring dozens of bills (you can access that list here), including recent activity on these issues:

Scope of Practice
Two bills raising scope of practice concerns are probably the first of many to emerge this session. As written, Assembly Bill 497 would allow advanced practice nurse prescribers to diagnose an illness or injury. Testifying before the Assembly Health and Healthcare Reform Committee public hearing on November 20, the Society informed the committee that state statutes and administrative rules are quite clear that the ability to make a medical diagnosis falls under physician expertise. The Society called for changes to the bill to eliminate any confusion on this point. You can read the Society testimony here.

Society staff also recently met with Rep. Scott Newcomer (R-Hartland), author of Assembly Bill 610, which makes audiology-related statutory changes. One section of the bill could be interpreted to grant audiologists broad power to diagnose and treat hearing-related ailments. Working with the Wisconsin chapter of the American Academy of Otolaryngology—Head and Neck Surgery, the Society provided Rep. Newcomer with substitute language that would eliminate any scope confusion. AB 610 is not yet scheduled for a public hearing.

Medical Liability
Dubbed the “family justice” bill, Senate Bill 138 would expand the group of claimants who can sue physicians for loss of society and companionship in medical malpractice cases. The bill adds adult children of a parent and parents of an adult child to the list of claimants that includes spouse, parent, minor sibling and minor children, who can sue on account of malpractice.

The Society opposed the bill at the October 17 public hearing (click here to read testimony), issued a Key Contact alert to physicians in districts of those senators on the committee voting on the measure, and circulated a letter from Society President Clarence P. Chou, MD asking for a “no” vote on the bill. Despite those efforts, the committee voted 6-1 to advance the bill to the Senate floor for further consideration.

If you are not a member of the Key Contact program, SB 138 shows why you should be—more physician constituent contacts are needed at strategic times to help influence policymakers’ decisions. Find out more about being a Key Contact here.

Constitutional amendment preventing IPFCF-like raids gets vote next Tuesday

Assembly Joint Resolution 34, which would add language to the Wisconsin Constitution barring raids on segregated funds like the Injured Patients and Families Compensation Fund, is scheduled for a vote in the State Assembly next Tuesday.

Amending the state constitution is a difficult process. Two consecutive sessions of the State Legislature must pass resolutions with the exact same language; then a referendum is placed on a statewide ballot for an up-or-down vote.

What you can do: Contact your state legislators and ask them to support AJR 34. When you call a member of the State Assembly, ask them to vote “yes” on the measure when it comes before them on the Assembly floor December 11. When calling your state senator, ask them to add their name as a cosponsor of AJR 34 and its Senate companion, SJR 24.

To find out your state legislators' contact information, click here.

Governor Doyle calls on Legislature to pass public health measures

On December 3, Governor Jim Doyle urged lawmakers to act next week on legislation that provides autism treatment and makes all public places smoke-free. The Society strongly supports both bills: Senate Bill 178, which requires health insurance to cover treatment for autism spectrum disorders, and Senate Bill 150, which prohibits smoking statewide in places of employment, restaurants, taverns and other indoor areas.

Autism spectrum disorder affects thousands of Wisconsin children at a rate of more than 1 in 200 children. Until recently, autism was considered a life-long disability with poor prognosis. Now, with early and appropriate treatment children can see dramatic improvements. Insurance companies are not required to cover the costs of these treatments, which means families across the state are paying thousands of out-of-pocket dollars for care.

As for SB 150, for nearly a year the Society has called for legislation banning smoking in all public places as part of the “It’s Time to Breathe Free Wisconsin” coalition.

Despite the Governor’s call, immediate progress on these bills is unlikely. A spokeswoman for Senate Majority Leader Russ Decker (D-Schofield) said that SB 178 will need to wait for a hearing before the Joint Committee on Finance. Senator Decker himself said that SB 150 will not make it to the Senate floor for a vote until a compromise is reached between bill author Senator Fred Risser (D-Madison) and Senator Roger Breske (D-Eland), who is concerned about the bill’s effect on state taverns.

For more information, contact Jeremy Levin.

Dec. 19 seminar will teach strategies to help patients quit smoking

You’re invited to join Society member Michael Fiore, MD, Wednesday, Dec. 19 for an informative and interactive 45-minute Web-based training designed to help physicians help their patients quit smoking.

Wisconsin’s first tobacco tax increase in more than six years takes effect in January. That, coupled with the annual New Year’s swell of quitters, offers a virtually unprecedented opportunity to intervene with patients whose tobacco use and dependence endangers their health and that of those around them. It’s a great time to quit and you can help smokers do it.

During this training, which is scheduled from 12:15 to 1 p.m., you will learn more about new medications, leading-edge methods and new Wisconsin resources to help your patients quit, and stay quit.

Doctor Fiore is a practicing internist, founder and 15-year director of the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI).

The seminar is sponsored by the Society, Smokefree Wisconsin and UW-CTRI. To sign up and receive login information, contact Jeremy Levin at 866.442.3800, ext. 3791.