2006 member advocacy priorities: Part 2 of 2

MGMA Connexion, Jul 2006 by Orr, Marilyn J

This is the second of a two-part article on the results of the member advocacy questionnaire detailing the priorities identified by the MGMA Government Affairs Committee and the MGMA Board of Directors. This status report summarizes the issues ranked 6-10 and updates MGMA's advocacy efforts.

6. Assignment of benefits policies

Medical group practices often have difficulty collecting fees for services rendered. Several states prohibit patients from assigning their benefits to their providers, requiring medical practices to bill insurance companies but collect payment from patients. Advocacy efforts would oppose such policies. MGMA would encourage insurers to allow patients to assign health insurance benefits directly to their providers.

Recent efforts by private payers, coupled with state laws and regulations, have made it harder for nonparticipating medical group practices to collect fees for services rendered when patients are prohibited from assigning their benefits to providers. These policies create difficulties in the provider-patient relationship. With assistance from MGMA state affiliates, we are investigating these private-payer policies and applicable state laws and regulations.

7. Industry adoption and promotion of health information technology

Members reflected the Association's concerns regarding the barriers to health information technology (HIT) adoption. The successful adoption of electronic health technologies depends on the willingness and ability of the federal government and the health care industry to encourage providers, health insurance plans, clearinghouses and others to understand and support them.

The Senate has approved legislation that requires federal HIT purchases to conform to data standards that promote quality and interoperability. It establishes an advisory body to the Department of Health and Human Services (HHS) and procedures to develop data standards and an IT certification program. In all those areas, the government and/or private sector have already acted, so the bill essentially would endorse and support those efforts.

The House of Representatives is considering legislation that reflects many of the Senate provisions. However, it includes a provision that calls for the implementation of the new International Classification of Diseases, 10th Revision, code set in both inpatient and outpatient settings by October 2009. MGMA is lobbying for a longer implementation time frame.

MGMA continues to support technology sharing, flexible and scalable federal initiatives, standardization and administrative simplification, and federal funding for HIT. HIT adoption would remain voluntary; providers would not be penalized for not adopting it. In addition, we focus advocacy efforts on removing legal barriers to widespread and rapid adoption of HIT.

8. Fair and effective pay-forperformance initiatives

Public and private efforts are under way to design programs to base a portion of provider reimbursement on performance in areas of quality, such as tracking adherence to clinical measures, patient satisfaction and resource use.

Congressional leaders have clearly signaled their unwillingness to repeal the sustainable-growth-rate-based reimbursement formula used by Medicare to cover provider services without moving Medicare toward some form of a pay-for-performance system. The Centers for Medicare & Medicaid Services (CMS) created the Physician Voluntary Reporting Program (PVRP), a voluntary program whereby medical practices can begin reporting performance measures on claims from April to June 2006 and receive reports in December.

MGMA continues to advocate that CMS assess the additional costs a medical practice must pay for quality reporting. This burdens practices without an electronic health record. Member concerns are related to the administrative complexity of gathering and reporting clinical data through an administrative claims system, as well as the measures themselves, some of which were designed as quality parameters for facilities and were not redesigned for the PVRP.

MGMA has reviewed and commented on several national insurers' projects that sought to affect the delivery of care through reimbursement. Such proposals have included nationwide programs to gather health plan measurements of clinical quality delivered in practices matched to the corresponding cost to the health plan.

The Association will continue to encourage the development of pay-for-performance programs that are feasible for medical practices, provide potential new sources of income and improve clinical care. We maintain that any such program:

* Must facilitate the accurate tracking and reporting of required data elements;

* Provide for voluntary provider participation;

* Insure fair and transparent methodology; and

* Ensure equitable implementation of program incentives.

9. Preserving office-based imaging

A number of forces - including changes in standards of care for many illnesses, expansion in coverage for new diagnostic imaging modalities and shifts in the site of service have resulted in the growth of imaging services. In an effort to combat a campaign to limit the ability of specialists to administer and interpret office-based imaging services, MGMA joined with other organizations to form the Coalition for Patient Centered Imaging (CPCI). CPCI contends that increased imaging among physicians arises from a desire to increase patient convenience and to have as much information as possible about a patient and his/her condition to develop accurate diagnosis and care regimens.