ASSH Weekly Member Upd@te
October 16th, 2009
A Message From the ASSH President
- A column from President Robert M. Szabo, MD
One Question
- View the results of last week's poll and answer this week's question
ASSH News
- New ASSH Candidate and Affiliate Members For 2009
ASSH Courses and Meetings
- Mark your Calendars for the 2010 Course Schedule
- AAOS/ASSH Advanced Elbow and Wrist Arthroscopy and Reconstruction Course
Healthcare Reform News
- Health System Reform Update and Online Resources - From AMA
- Senate To Vote On SGR This Monday - From AMA
- Health Care Reform Update - New Senate Developments - From AAOS
- CBO Estimates Tort Reform Could Save $41 Billion Over 10 Years - From AAOS
A Message From the ASSH President
This week, Dan Nagle, MD, has been invited to address a recent member problem posted on the ASSH listserv.
From Dan Nagle, MD, Practice Division Director:
Dr. Bob Terrill in his ASSH Listserv posting of September 10, 2009 highlighted the problem of arbitrary and unfounded coverage denials by insurance companies. His posting is included below.
“Colleagues – especially those in Massachusetts – I have just been told by my practice manager that Tufts health plan has now unilaterally decided that 64708 is now an “experimental” procedure and as such will not longer be a covered procedure. I have attempted to contact the medical director without success. This has been done unilaterally without any evidence to back it up, etc. I do not know about any of you, but I do these procedures. This includes proximal median nerve decompression, radial tunnel decompression, suprascapular nerve decompression, peroneal nerve decompression, tibial tunnel decompression, etc. It floors me that the insurance company can just do this. Here in Massachusetts, BCBS and Medicare decided that iontophoresis is experimental and have now denied its coverage. This is even though there is at least 20 years of PT published data noting its effectiveness. This now has the potential to hurt our patients. Have you seen this? Do you have any suggestions? I have considered contacting the Insurance Commissioner, but do not know what good that will do. If everything we do is under scrutiny, and the effectiveness of procedures needs to be documented, don’t we also need data that denying needed care will also harm patients?”
Many concerned and well informed ASSH members chimed in and provided Dr. Terrill with suggestions regarding how to deal with this issue. Proposed avenues of response included legal action and intervention through legislative initiatives. Dr. Andy Gurman, a long time ASSH member and Vice Speaker of the American Medical Association (AMA) House of Delegates provided contact information for the Massachusetts Medical Association.
Dr. Desirae McKee suggested a large-scale survey of surgeons could be helpful in assessing the magnitude of the problem and possibly provide data that could be used in future efforts to curtail inappropriate insurance coverage denials. Stimulated by Dr. McKee’s suggestion, our President Dr. Robert Szabo along with Dr. Dan Nagle created a survey probing our members’ inappropriate insurance denial experience. The survey results are summarized below: (view complete survey results)
Thirty six percent of those who responded (121/332) indicated they had experienced a denial for payment because the insurer had arbitrarily designated a well-established procedure as being “experimental.” The denials concerned a wide variety of procedures. One respondent reported 186 such denials!
Blue Cross and Blue Shield was the most frequently cited offending company with Aetna, United Health Care and Cigna not far behind.
Only 31 members answered the question regarding avenues of appeal. (Three hundred seventeen members skipped this question.) Twenty-three (74%) indicated they did not pursue an appeal.
Members from all over the country responded to the survey. Members in 30 different states responded saying they had experienced a denial for payment because the insurer has arbitrarily designated a well established procedure as being experimental. It appears the issue is prevalent in all areas of the country.
Our members provided many “pearls of wisdom” regarding how to deal with inappropriate denials. Hopefully, these “pearls” will help others as they deal with inappropriate insurance denials.
To view Dr. Nagle's message on the ASSH Advocacy site, use this link.
One Question
Last week, we asked if you give antibiotics preoperatively to your patients with CTS. To view the results of the survey, go here. This week, we want to hear your thoughts on formats for surgical videos. To participate in the survey, use this link.
ASSH News
The final group of new ASSH Candidate and Affiliate Members have been added for 2009!
CONGRATULATIONS!!!!! to the entire class of 2009 Active, International, Honorary, Candidate and Affiliate Members!
ASSH Courses and Meetings
2010 Courses - Mark Your Calendars!
*For more information, or to register for any of these courses, use this link.*
February 5-6, 2010
Electives in Hand Surgery (Jointly Sponsored with the ASHT)
Intercontinental New Orleans - New Orleans, LA
March 13, 2010
AAOS Specialty Day: Wrist and Elbow Update: The Devil is in the Details
New Orleans, LA
May 21-22, 2010
Master Skills Course in Hand and Wrist Trauma
Orthopaedic Learning Center - Rosemont, IL
July 15, 2010
General Orthopaedic Review (Co-Sponsored with the AAOS)
Renaissance Chicago - Chicago, IL
July 16-18, 2010
Comprehensive Review in Hand and Upper Extremity Surgery
Renaissance Chicago - Chicago, IL
August 6-7, 2010
Wrist and Elbow Arthroscopy
Orthopaedic Learning Center - Rosemont, IL
October 6, 2010
28th Annual Adrian E. Flatt Residents and Fellows Conference in Hand Surgery
John B. Hynes Convention Center - Boston, MA
October 7-9, 2010
65th ASSH Annual Meeting: Embracing Excellence-Making a Difference
John B. Hynes Convention Center - Boston, MA
Refine Your Skills and Learn New Techniques
Learn and practice the most effective arthroscopic approaches for the elbow and wrist as well as the latest, advanced techniques for contracture release, fracture treatment, and stabilization at the AAOS/ASSH Advanced Elbow and Wrist Arthroscopy and Reconstruction surgical skills course. This in-depth course blends didactic instruction, faculty demonstrations, debates, and ample hands-on lab practice to help you clarify the pros and cons of various treatments and impart a new skill set or level of comfort with addressing traumatic and degenerative problems.
Sessions begin at 6:00 pm on Thursday evening, November 12 and continue through Saturday, November 14. This course is designated for a maximum of 19 AMA PRA Category 1 Credits™. For more information or to register, call AAOS Customer Service toll-free at 1-800-626-6726 from 8:00 am – 5:00 pm Central Time, or visit the AAOS website online at www.aaos.org/3331.
Healthcare Reform News
Health System Reform Update and Online Resources - From AMA
The U.S. Senate Finance Committee concluded its markup October 13th and voted 14-9 to approve its draft health system reform proposal. Sen. Olympia Snowe (R-Maine) joined the panel's Democrats to support the proposal; all other committee Republicans voted against it. While it's possible that Senate floor action could begin next week, many observers anticipate the full Senate will not take up health reform legislation until the week of Oct. 26. The Senate leadership is working to merge the committee's proposal with one passed last July by the Senate Committee on Health, Education, Labor, and Pensions.
The AMA has recently updated their Health System Reform website to include key information to help physicians in their efforts related to S 1776. You can go to their website for talking points on this legislation and other health system reform resources by following this link.
The AMA Urges You to Call (800) 833-6354 to Ask Your Senators to Support S. 1776
On Oct. 13, Sen. Debbie Stabenow (D-Mich.) introduced S. 1776, the "Medicare Physicians Fairness Act of 2009," which the Senate leadership announced yesterday will serve as the Senate legislative vehicle for eliminating Medicare's sustainable growth rate (SGR) formula and laying the foundation for establishing a new Medicare physician payment update system.
S. 1776 will be the subject of a cloture vote on Monday, Oct 19. The Senate needs 60 votes to invoke cloture to allow formal consideration of the bill. A vote on final passage is expected to occur late next week, either on Oct. 22 or 23. Senate Majority Leader Harry Reid (D-Nev.), Senate Finance Committee chairman Max Baucus (D-Mont.), and Sen. Chris Dodd (D-Conn.), along with President Barack Obama, are all strongly supporting passage of S. 1776.
Sen. Stabenow's 18-line bill repeals the SGR formula and eliminates all debt that has been accumulated under the current payment system, setting future physician payment updates at zero. Importantly, the Senate leadership made it very clear yesterday that Congress does not intend to implement a permanent physician payment freeze and call it Medicare payment reform.
Rather, by passing a separate bill that repeals the SGR and eliminates the accumulated spending target debt, budget constraints will be eased, allowing a new physician payment update system to be incorporated into a broader health system reform bill. The details of that future update system have not yet been worked out, although certainly the two spending targets that would be created by the U.S. House of Representatives health system reform legislation, H.R. 3200, could be viewed as a starting point.
The procedural path for passing S. 1776 will be complicated, requiring the support of 60 senators on several procedural motions over the next few days. Furthermore, because the legislation is not offset by other spending cuts or revenue increases it will add to the federal budget deficit, raising its controversy and making supporting votes difficult for some senators.
Repealing the SGR is one policy objective that is a common goal for all physicians. Sen. Stabenow's bill creates the pathway the AMA has been seeking to finally achieve that goal. Grassroots activism will be absolutely critical to the success of this strategy.
The AMA has activated its physician and patient grassroots networks, and will be running television advertisements in key states. A unified and concentrated effort by the entire house of medicine will be essential to the AMA's success.
Visit the AMA's grassroots action center to send an e-mail to your senator or call (800) 833-6354 now and urge your senators to support S. 1776. This bill would not only stop the Jan. 1, 2010, Medicare cuts of more than 20 percent, it also would repeal the flawed SGR payment formula and start us down the path toward ensuring that physicians can continue caring for Medicare patients.
Healthcare Reform Update - New Senate Developments - From AAOS
Since I last updated you, the Senate has begun merging the recently passed Finance Committee proposal with the Health, Education, Labor and Pensions (HELP) Committee’s proposals into a single health care reform bill. The merged bill was expected to be brought to the Senate floor early next week; however, a new development has altered the planned schedule.
Tuesday evening, Senator Debbie Stabenow (D-MI) introduced the “Medicare Physician Fairness Act of 2009,” S. 1776, to be considered by the Senate separately from current health care reform proposals. In conjunction with Senator Stabenow’s announcement, the Administration and Democratic leadership announced their support for this bill.
S. 1776 would repeal the sustainable growth rate (SGR) formula and eliminate all debt that has been accumulated under the current payment system. The bill indefinitely freezes reimbursement rates and sets physician payments at current levels.
The AMA and the ACS are vigorously supporting S. 1776 (as is AARP) and have initiated a grassroots campaign to gain support. We applaud the recognition that this broken formula must be eliminated. While the repeal of the SGR is a stated policy of the AAOS (Position Statement), this bill does not address the second part of the AAOS’ adopted policy position to replace the broken SGR system. The repeal of SGR must be followed by a replacement of the flawed formula with a formula that is fully paid for without borrowing from future Medicare payments, that is sustainable long-term, and that more closely reflects the actual increased practice cost as measured by the MEI.
The AAOS is not opposed to S. 1776, but the AAOS cannot lend its active support to an incomplete solution. It is argued that this bill paves the way for a permanent fix to the SGR formula. While we certainly hope this is the case, we cannot support legislation that does not exist.
We expect S. 1776 to be introduced in the Senate as soon as Monday with a final decision in the Senate by the end of the week. The critical debate on the current health care reform packages will begin in the weeks following when both the Senate and the House bring their respective legislation to the floor. We will make a decision to actively support or oppose these bills in the very near future and will notify our members. At that time we expect to initiate our own grassroots campaign to achieve maximal impact. We will keep the entire membership informed of all developments.
I welcome your thoughts on this issue and on health care reform. I urge each of you to stay engaged in the coming weeks. We will continue our efforts to both keep the Fellowship informed and to represent the AAOS in our efforts to engage and inform Congress.
Sincerely, Joseph D. Zuckerman, MD
CBO Estimates Tort Reform Could Save $41 Billion Over 10 Years - From AAOS
In a letter to U.S. Sen. Orrin Hatch (R-Utah), the Congressional Budget Office (CBO) states that there is evidence to suggest that implementing a typical package of tort reform proposals could reduce healthcare spending in the United States by approximately 0.5 percent, or about $11 billion in 2009. CBO defines a typical package in part as a $250,000 cap on noneconomic damages, along with a cap on punitive damages of $500,000 or two times the award for economic damages, whichever is greater. The agency estimates that enactment of such a package would reduce mandatory spending for Medicare, Medicaid, the Children’s Health Insurance program, and the Federal Employees Health Benefits program by roughly $41 billion over the next decade.
Read more...(registration required)
Read the letter (PDF)…
Read the AAOS Position Statement on Medical Liability Reform (PDF)…